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2019 HSR&D/QUERI National Conference Abstract

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1121 — Preventing Facilitator Burnout: Strategies for More Sustainable Process Improvement

Lead/Presenter: Tanya Olmos-Ochoa,  COIN - Los Angeles
All Authors: Olmos-Ochoa TT (Care Coordination QUERI; HSR&D Center for Healthcare Innovation, Implementation and Policy), David A. Ganz (Care Coordination QUERI; HSR&D Center for Healthcare Innovation, Implementation and Policy), Jenny M. Barnard (Care Coordination QUERI; HSR&D Center for Healthcare Innovation, Implementation and Policy) Lauren Penney (Veterans Evidence-based Research Dissemination and Implementation Center (VERDICT), South Texas Veterans Health Care System) Neetu Chawla (Care Coordination QUERI; HSR&D Center for Healthcare Innovation, Implementation and Policy)

A substantial evidence base supports the use of practice facilitation as an effective strategy to enable implementation of evidence-based practices and related quality improvement (QI) efforts in learning healthcare systems. Yet, challenges with implementing and maintaining facilitation exist and may impede efforts to grow and sustain an experienced facilitator workforce. This study identifies potential challenges facilitators may experience when working with QI teams and recommends strategies to address these challenges.

The Coordination Toolkit and Coaching (CTAC) project is an effort of the Care Coordination Quality Enhancement Research Initiative (QUERI) program to improve patient experience of care coordination in primary care. Using a cluster-randomized design, 12 primary care clinics were randomized to either a passive strategy (access to the CTAC online toolkit) or an active strategy (distance-based coaching plus access to the toolkit). Over a 12-month period, two facilitators delivered weekly, one-hour coaching calls to six clinics implementing a QI project of the clinic's choice. Data sources included facilitator reflections catalogued after all coaching calls (n = 223) and notes from debrief sessions between facilitators.

We identified nine facilitation stressors: lack of progress/follow-through; changes to the coached team; emotion/frustration directed at the facilitator; mismatched expectations between the facilitator and coached team; managing project timeline and deliverables; supporting QI methods and data collection; managing team dynamics; promoting effective communication; and documenting implementation and facilitation processes. Given these stressors, we recommend that facilitators: continually re-assess process improvement activities and QI methods (e.g., aligning goals with project timeline); moderate discussions to help anticipate and resolve common challenges to process improvement (e.g., staffing turnover, within-team conflict); support teams with appropriate data collection and analysis; and set aside time to self-reflect (e.g., debrief sessions), discuss (e.g., with a co-facilitator), and make necessary adjustments to their facilitation process.

Understanding how facilitation affects facilitators and providing facilitators with tools to address stressors are essential for sustainability of QI and other process improvement efforts, and for continued use of facilitation as an implementation strategy.

Identifying facilitation stressors and strategies to overcome them may enhance the development and maintenance of an experienced facilitator workforce to support the next generation of process improvement.