QUERI – Quality Enhancement Research Initiative

QUERI E-news
May 2020

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QUERI Guides Virtual Facilitation of New Innovations Due to COVID Travel Restrictions

The Implementation Facilitation Learning Collaborative (IFLC) is a learning collaborative developed and facilitated by Behavioral Health QUERI; it is comprised of a community of researchers and implementation practitioners interested in applying and studying implementation facilitation. The goal of the IFLC is to provide a platform for participants to share what they are learning with one another and to work collaboratively to advance the science and practice of implementation facilitation.

Takeaway: QUERI investigators helped gather and disseminate effective virtual implementation support strategies – focusing on implementation facilitation – to help frontline providers successfully implement and sustain new clinical programs and practices.

Due to recent VA travel restrictions, and Centers for Disease Control and Prevention (CDC) as well as World Health Organization (WHO) recommendations, many facilitation projects no longer have the option to travel for site visits and must consider alternative processes. In 2015, there was a VA travel ban, and a workgroup was formed that compiled an expert consensus statement addressing facilitation in a virtual format. Since virtual capabilities have evolved and advancements have been made, leadership from the Behavioral Health QUERI Implementation Facilitation Training Hub solicited updates from members of the Implementation Facilitation Learning Collaborative (IFLC) with recent virtual facilitation experiences in order to identify new challenges and generate solutions to inform current implementation facilitation practice during the COVID-19 pandemic.

Rapid Response

Early in the COVID-19 crisis the Behavioral Health QUERI Implementation Facilitation Training Hub had three requests for information on virtual facilitation over a two day period. Within four weeks of these requests, Dr. Katherine Dollar led an HSR&D Cyberseminar titled Updated Virtual Facilitation Guidance: Innovation, Challenges and Opportunities, presenting both the 2015 expert consensus and updated best practices identified through the IFLC. JoAnn Kirchner, MD (Principal Investigator for the Behavioral Health QUERI Training Hub), Jeffrey Smith, and Eva Woodward, PhD, also participated in the presentation. Following are highlights from this HSR&D Cyberseminar.

Implementation Facilitation

Implementation facilitation offers a multi-faceted implementation strategy involving interactive problem-solving and support, particularly within the context of interpersonal relationships among stakeholders. There is evidence that implementation facilitation works: systematic reviews have found that primary care practices were almost three times more likely to adopt evidence-based guidelines through facilitation. But how do implementation facilitators facilitate when face-to-face meetings are restricted by a deadly pandemic? Even without a global pandemic, new clinical innovations are challenging to implement. Common barriers can include a difference across healthcare facilities in their readiness to participate – or the limited availability of providers to participate in implementation activities.

But how do implementation facilitators facilitate when face-to-face meetings are restricted by a deadly pandemic?

Given the demands placed by the pandemic on all healthcare facilities, two QUERI-funded investigation teams gave study participants a choice – they could put their projects on hold, while directly responding to the COVID-19 crisis, or they could move forward with QUERI’s help in supporting the implementation with minimal burden on healthcare providers. The response QUERI received was tremendous.

“The sensitivity that you all have demonstrated has touched my heart greatly. You are a model of leadership done right.”

“…greatly appreciate your thoughtful approach, and we’ll support facility decisions on best timing to move project forward!”

Virtual Implementation Facilitation Strategies

For locations that decide to move forward, QUERI investigators recommend offering virtual implementation facilitation, over a variety of technological platforms, phone calls, video teleconferencing, and advanced technologies (i.e., combined audio, video, and viewing/creation of shared documents). In addition, implementation facilitators recommend several ways in which to optimize virtual facilitation, such as ensuring technology support, allowing time for informal interactions that build trust, accepting that things will take longer, actively listening, and increasing enthusiasm to maintain momentum.

QUERI implementation facilitators also note that some locations are not accustomed to virtual options, so it was important not to overestimate their technical savvy – and to schedule brief “practice” sessions to identify and trouble-shoot any problems with the technology. If the use of video is not an option, they suggest creating a PowerPoint presentation that includes everyone’s pictures to be used during introductions. If the technology is available, they suggest an interactive virtual tour, maps or floorplans, or a walk-thru using a virtual platform. Whatever the circumstances, QUERI stresses these key points for successful application of implementation facilitation:

  • Be of use,
  • Focus on the relationship, and
  • Be flexible during this unpredictable time for all healthcare systems.

For more information, contact Katherine Dollar, PhD, at Katherine.Dollar@va.gov .

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