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Smith JL, Spollen JJ, Owen RR. Facilitation in Implementing Evidence-Based Practices of Schizophrenia: Researcher & Clinical Leader Perspectives. Presented at: AcademyHealth Annual Research Meeting; 2007 Jun 3; Orlando, FL.
Research Objective: 'External facilitation' is a technique used by implementation researchers to work actively with clinical stakeholders to enable the uptake of evidence into practice. This abstract reports researcher and clinical leader perspectives on external facilitation activities and lessons learned in a Veterans Health Administration (VHA) Mental Health Quality Enhancement Research Initiative (MH QUERI) project to implement evidence-based antipsychotic medication management for patients with schizophrenia. Study Design: Descriptive case study of external facilitation applied by researchers in partnership with VA medical center staff implementing a team-based quality improvement (QI) intervention, educational materials, and performance monitoring tools to improve antipsychotic medication management for patients with schizophrenia. Population Studied: VA medical center mental health clinicians Principal Findings: The external facilitator maintained regular contact with the QI team to monitor implementation of project tools/strategies, identify barriers, problem-solve, and assist in adapting tools/strategies as needed. Facilitation resulted in placement of recommendations for antipsychotic dosing and side effect monitoring on medication order screens, enhanced performance reports tailored to clinician preferences and specifications, and development of weekly provider-specific reports identifying patients in need of metabolic side effect monitoring. Side effect monitoring was considerably improved subsequent to implementing the weekly monitoring reports, moving the medical center from non-compliance to compliance with network-level performance measures for antipsychotic side effect monitoring. Weekly reports continue to be utilized and monitoring improvements have been sustained for one year after the research project concluded. From the researcher perspective, lessons learned include: (1) external facilitators need to be flexible to accommodate suggestions of clinical partners for modifying tools/strategies when initial efforts have limited success, (2) rapid response to clinical partner concerns is optimal but not always feasible due to time/availability issues; and (3) there is a need to establish boundaries for what facilitators will and will not do for clinical partners to minimize potential for misunderstandings. From the clinical leader perspective, external facilitation: (1) placed too much initial emphasis on promoting provider education strategies; and (2) encouraged innovation to emerge from within the clinical team by actively eliciting and responding to clinical staff feedback on needed refinements/augmentations to intervention tools. Conclusions: External facilitation as an implementation strategy may foster collaborative relationships between researchers and clinical leaders that can successfully encourage the adoption and sustained use of evidence-based practices. Implications for Policy, Delivery or Practice: The process of external facilitation may be a generalizable approach researchers can use to implement evidence-based care in routine clinical practice. New organizational structures or mechanisms may be needed to support such research-clinical partnerships.
