Transferring Implementation Facilitation Knowledge and Skills to Improve Healthcare Delivery Systems

Evidence based practices and programs can improve healthcare quality but many organizations lack the ability to implement and sustain them. Skilled implementation facilitators applying a range of interventions can enable healthcare systems to address these challenges. However, we have limited knowledge about skills facilitators need and no studies examine how experts can transfer skills to others to build capacity for implementation efforts. The purpose of this study is to address these gaps. For this qualitative descriptive study, I conducted content analysis of data previously collected from an expert and two novice facilitators to whom she was transferring skills for supporting implementation of evidence based programs mandated by VA policy. This study explores what knowledge and skills the expert transferred and how she transferred them. Because no studies have explored the latter, a literature review on other methods that foster learning through social interactions informed the analysis. The findings confirm that implementation facilitators need a range of complex knowledge and skills. I identified, operationalized and categorized these into communication skills and five overarching skillsets for (a) building relationships and creating a supportive environment, (b) changing the system of care and the structure and processes that support it, (c) transferring knowledge and skills and creating infrastructure support for ongoing learning, (d) planning and leading change efforts, and (e) assessing people, processes and outcomes and creating infrastructure for program monitoring. The findings also reveal that the expert utilized a wide variety of techniques and processes for transferring those skills, including active and participatory methods, cognitive, psychosocial, self learning and structural learning supports, and interactive relational processes. Additionally, the expert continuously monitored and assessed facilitators she was training and adapted both the content and process to learner characteristics and pre existing skills, as well as the organizational context. The findings address gaps in the current literature and can inform the design, creation, and administration of facilitation programs by policy designers or managers, experts' transfer of implementation facilitation knowledge and skills, and materials for supporting these efforts. Application of findings has the potential to improve implementation of evidence based programs in healthcare delivery systems. Acknowledgements I would like to thank the members of my dissertation committee for their guidance and patience. My chair, Dr. Brinck Kerr, probably thought I would not complete the process but he never quit asking, "when" I am grateful that he allowed me the privilege of conducting this research in a manner that facilitated the achievement of my goals, as well as those of the University. Because of his patience. I enjoyed much of the process and learned far more than I hoped. I am grateful to Dr. Louise Parker for all that she taught me long before and during the dissertation process. I have such respect for her as an organizational scientist and qualitative methodologist that her "well done" was the mirror that allowed me to believe that, indeed, it was. I also thank Dr. Geoffrey Curran, who introduced me to implementation science over a decade and a half ago. I am grateful to Dr. JoAnn Kirchner for her support throughout the dissertation process. It was her belief in me that led me to seek a doctoral degree and her work that led me to conduct this research. I also thank my dear friends, Peggy Cryer and Sandra Pate for patiently waiting for me to complete this process. Finally, I especially want to thank my family, my son, Michael (always an advocate for balance in life) my daughter in law, Monica, and grandson, Kaleb, for sharing their lives with me, believing in me, and cheering me on.  This work is dedicated to my son, Michael, and my daughter, Christy, who I miss. Their lives and love have brought me great joy. Children are truly a gift from the Lord.