Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4077 — Blended Facilitation to Support Implementation Efforts in VHA Community Living Centers

Lead/Presenter: Camilla Pimentel, COIN - Bedford/Boston
All Authors: Pimentel CB (HSR&D Center for Healthcare Organization and Implementation Research (CHOIR), Bedford/Boston, MA) Mills WL (HSR&D Center for Innovation in Quality, Effectiveness and Safety, Houston, TX) Snow AL (Tuscaloosa VA) Palmer JA (Hebrew Rehabilitation Center) Allen RS (Alabama Research Institute on Aging) Wewiorski NJ (CHOIR) Hopkins SD (Tuscaloosa Veterans Affairs Medical Center) Hartmann CW (CHOIR)

Objectives:
Nursing homes present myriad challenges to researcher-led implementation of innovative practices, including poor staff engagement and protocol adherence. Blended facilitation, which engages researchers (external facilitators) and stakeholders (internal facilitators) through collaborative problem-solving and support, may strengthen implementation efforts in this setting. This strategy, however, is poorly described and underused in implementation studies performed in nursing homes. We describe our experience with blended facilitation and the processes of relationship- and skill-building with internal facilitators during a recent implementation study in VHA Community Living Centers (CLCs).

Methods:
We conducted a mixed-methods formative evaluation of a blended facilitation approach to implementing an intervention to improve resident-centered care in 12 units across 6 CLCs. External facilitators were VHA researchers with expertise in implementation methods (N = 9) and internal facilitators were local CLC leaders or staff members who supported implementation activities (N = 43). Qualitative data were collected from external facilitators' field notes and semi-structured interviews with internal facilitators. We conducted matrix analysis guided by an established facilitation audit tool to identify instances of facilitation activities, best practices, and lessons learned. Quantitative data, collected through weekly surveys of internal facilitators regarding their experiences with the intervention and barriers related to its implementation, was analyzed with descriptive statistics.

Results:
Blended facilitation activities included: "getting to know you" and training teleconferences prior to study implementation, weekly "check-in" calls, problem-focused brainstorming sessions as-needed, and video-based training reinforcement. Best practices included adjusting the intensity of external facilitation to the needs of internal facilitators and designating alternate "champions" to maintain momentum during internal facilitators' absences. Lessons learned for the external facilitators included the importance of keeping training brief, providing easily digestible feedback on intervention progress, making optimally targeted CLC staff/leadership connections, and developing additional resources (e.g., scripts) to support internal facilitation efforts. Quantitative analyses found that, over time, internal facilitators reported more positive experiences during intervention-focused huddles with staff (P = .014).

Implications:
Deliberate and ongoing blended facilitation was well-received and helped foster meaningful partnerships between external and internal facilitators.

Impacts:
Blended facilitation may be a powerful tool for accelerating implementation of innovative care practices across CLCs and other clinical settings by strengthening relationships between researchers and key stakeholders.