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2019 HSR&D/QUERI National Conference Abstract

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1144 — Getting to Fidelity: Identifying Core Components of Implementation Facilitation Strategies

Lead/Presenter: Jeffrey Smith,  COIN - North Little Rock
All Authors: Smith JL (QUERI for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System), Ritchie MJ (QUERI for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System), Kim B (VA Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System) Miller CJ (VA Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System) Chinman MJ (Center for Health Equity Research & Promotion, VA Pittsburgh Healthcare System) Landes SJ (QUERI for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System) Kelly PA (Southeast Louisiana Veterans Health Care System) Kirchner JE (QUERI for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System)

Objectives:
To ensure appropriate application and spread of successful implementation strategies, it is important to use tools or processes to measure and support fidelity to a given strategy's core components. Unfortunately, this aspect of implementation science is underdeveloped and infrequently applied. Implementation facilitation (IF) is a dynamic strategy involving interactive problem-solving and support to help clinical personnel implement and sustain a new program or practice that occurs in the context of a recognized need for improvement and a supportive interpersonal relationship. Identifying core components of IF is a foundational step in efforts to develop tools to assess fidelity to the strategy.

Methods:
First, we conducted a scoping literature review to identify the range of activities applied in IF strategies. PubMed, CINAHL, and Thompson Scientific Web of Science databases were searched for English-language articles that included the term "facilitation" or other commonly used terms for the strategy published from January 1996 - December 2015. Initially, 1,489 citations/abstracts were identified and screened for relevance by two independent reviewers. Ultimately, 135 articles (from 94 studies) were identified for abstraction of data on facilitator characteristics and roles/activities, clinical setting, patient population, clinical innovation targeted for implementation, and implementation outcomes. Next, we engaged an Expert Panel in a rigorous 3-stage modified Delphi process to develop consensus on core IF activities for high complexity and low complexity clinical innovations in three implementation phases (pre-implementation, implementation, sustainment).

Results:
Based on review of the literature for the 94 studies, 32 distinct IF activities were identified. The expert panel identified 8 of the 32 IF activities as core for the Pre-Implementation Phase, 8 core IF activities for the Implementation Phase, and 4 core IF activities for the Sustainment Phase.

Implications:
Core IF activities were identified based on a comprehensive literature review and a rigorous consensus development process with an expert panel. Next steps are to develop a prototype IF Fidelity Tool based on the core IF activities for piloting.

Impacts:
Effective transfer of successful IF strategies from research to operations requires tools to help ensure fidelity to core components of the strategy. Identifying core activities for IF strategies is an important step toward that goal.