Programme no. 422-OP
Quality Improvement
Practice facilitation – the black box
Tina Due*1, Frans Boch Waldorff2, Marius Brostrøm Kousgaard3, Thorkil Thorsen 4
1The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen,Copenhagen,Denmark, 2The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen¨and Research Unit of General Practice, Department of Public Health, University of Southern Denmark,Copenhagen, Odense,Denmark, 3The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen,Copenhagen,Denmark, 4The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen,Copenhagen,Denmark
* = Presenting author
Objectives: The purpose of this case study was to explore how the act of facilitation is practiced among peer facilitators in general practice, to further the understanding of the concept and provide areas of attention for future intervention design and reporting.

Background: Practice facilitation is widely used internationally in guideline implementation and practice development in primary care. It involves an external person visiting the practice and supporting a process of change. However, there is limited conceptual clarity and lacking knowledge of the enactment of facilitation.
Results: In this case of peer GP facilitation diverse facilitation modes were present. The facilitators passed on inspiration and enthusiasm towards practice change and implementation of new systems, provided experienced based and factual knowledge through presentations and hands-on approaches and became a deadline rather than enabling reflection and internal discussion at the visits. Despite elements of a practice driven approach there were also several examples of facilitator driven elements. Several variations appeared in the enactment of facilitation, regarding choice of topic, structure of the visits, facilitation mode and degree of practice versus facilitator driven aspects. Variations seemed influenced by both variations between practices and variations between facilitators due to differences in their translation of the concept of facilitation.
Material/Methods: The case is a facilitator project from Capital Region of Denmark. The project purpose was to support implementation of disease management programmes in general practice. Practices were offered three one-hour visits by a GP facilitator. The facilitator was to be a sparring partner and colleague rather than an expert.

An explorative approach was chosen in both data collection and analysis. Project initiators and managers were interviewed. 28 facilitator visits were observed in 13 practices. The 10 facilitators from the observed visits were interviewed and focus groups were made with all facilitators. A thematic analysis was performed using an inductive approach.

Conclusion: Facilitation is a complex concept in both perception and enactment. Diversity in facilitation modes, practice versus facilitator driven processes and practice versus facilitator dependent variations highlight a need for caution when comparing studies and a need for further discussions of the concept of facilitation.
Points for discussion: What is the preferred balance between different facilitation modes, does it make sense to combine them in one concept and is it meaningful to talk of facilitation as a continuum of approaches?

What are the challenges of facilitators being peers?