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Blended Facilitation as an Effective Implementation Strategy for Quality Improvement and Research in Nursing Homes

Pimentel, Camilla B., PhD, MPH; Mills, Whitney L., PhD; Palmer, Jennifer A., PhD, MS; Dillon, Kristen, PsyD; Sullivan, Jennifer L., PhD; Wewiorski, Nancy J., PhD; Snow, Andrea Lynn, PhD; Allen, Rebecca S., PhD, ABPP; Hopkins, Susan D.; Hartmann, Christine W., PhD

doi: 10.1097/NCQ.0000000000000376
Articles: Methods Discussion

Background: Blended facilitation, which leverages the complementary skills and expertise of external and internal facilitators, is a powerful strategy that nursing stakeholders and researchers may use to improve implementation of quality improvement (QI) innovations and research performed in nursing homes.

Problem: Nursing homes present myriad challenges (eg, time constraints, top-down flow of communication, high staff turnover) to QI implementation and research.

Approach: This methods article describes the theory and practical application of blended facilitation and its components (external facilitation, internal facilitation, relationship building, and skill building), using examples from a mixed QI and research intervention in Veterans Health Administration nursing homes.

Conclusions: Blended facilitation invites nursing home stakeholders to be equal partners in QI and research processes. Its intentional use may overcome many existing barriers to QI and research performed in nursing homes and, by strengthening relationships between researchers and stakeholders, may accelerate implementation of innovative care practices.

New England Geriatric Research, Education and Clinical Center (Dr Pimentel), Hospice and Palliative Care (Dr Dillon), and Center for Healthcare Organization and Implementation Research (Drs Wewiorski and Hartmann), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts (Dr Pimentel); Center for Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island (Dr Mills); Institute for Aging Research, Hebrew SeniorLife, Roslindale, Massachusetts (Dr Palmer); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts (Dr Sullivan); Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston, Massachusetts (Drs Sullivan and Hartmann); Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, Alabama (Dr Snow and Ms Hopkins); and Alabama Research Institute on Aging and the Department of Psychology, The University of Alabama, Tuscaloosa (Drs Snow and Allen).

Correspondence: Camilla B. Pimentel, PhD, MPH, New England Geriatric Research, Education and Clinical Center, Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Rd (182B), Bedford, MA 01730 (

The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. This work was supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development (I01HX000797) and Rehabilitation Research and Development (IK2RX001241 to W.L.M.), and the National Cancer Institute (R25CA172009 to C.P.).

The authors declare no conflicts of interest.

Accepted for publication: October 15, 2018

Published ahead of print: November 21, 2018

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