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Types of internal facilitation activities in hospitals implementing evidence-based interventions

Baloh, Jure; Zhu, Xi; Ward, Marcia, M.

doi: 10.1097/HMR.0000000000000145

Background: Implementation models, frameworks, and theories recognize the importance of activities that facilitate implementation success. However, little is known about internal facilitation activities that hospital personnel engage in during implementation efforts.

Purpose: The aim of the study was to examine internal facilitation activities at 10 critical access hospitals in rural Iowa during their implementation of TeamSTEPPS, a patient safety intervention, and to identify characteristics that distinguish different types of facilitation activities.

Methods: We followed 10 critical access hospitals for 2 years after the onset of implementation, conducting quarterly interviews with key informants. On the basis of the transcripts from the first two quarters, a coding template was developed using inductive analyses. The template was then applied deductively to code all interview transcripts. Using comparative analysis, we examined the characteristics that distinguish between the facilitation types.

Results: We identified four types of facilitation activities—Leadership, Buy-in, Customization, and Accountability. Individuals and teams engaged in different types of facilitation activities, both in a planned and an ad hoc manner. These activities targeted at both people and practices and exhibited varying temporal patterns (start and peak time).

Conclusion: There are four types of facilitation activities that hospitals engage in while implementing evidence-based practices, offering a parsimonious way to characterize facilitation activities. New theoretical and empirical research opportunities are discussed.

Practice Implications: Understanding the types of facilitation activities and their distinguishing characteristics can assist managers in planning and executing implementations of evidence-based interventions.

Jure Baloh, MHA, is Graduate Research Assistant and PhD Candidate, Department of Health Management and Policy, University of Iowa. E-mail:

Xi Zhu, PhD, is Assistant Professor, Department of Health Management and Policy, University of Iowa.

Marcia M. Ward, PhD, is Professor, Department of Health Management and Policy, University of Iowa.

This research was supported by funding from the Agency for Healthcare Research and Quality (R18HS018396 and R03HS024112). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

This study was presented at the 8th Annual Conference on the Science of Dissemination and Implementation in Health, Washington, DC, on December 15, 2015.

The research was reviewed and approved by University of Iowa Institutional Review Board.

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

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