Strategies, not background, key for facilitators to help physicians improve practices

Strategies to identify challenges and engage staff, not professional background, can be keys to greater effectiveness for facilitators who help primary care physicians improve their practices.

The finding was part of a new study that examined how facilitators were more or less effective in contributing to organizational change and clinical outcome improvements for medical practices. The data came from EvidenceNOW: Advancing Heart Health, a large-scale primary care practice change initiative that the federal Agency for Healthcare Research and Quality (AHRQ) launched in 2015.

Advancing Heart Health engaged seven regional grantees, called cooperatives, spanning 12 states with 1,630 medical practices involved, and facilitators who worked with at least four practices.

Facilitators were deemed more effective if at least 75% of the practices they worked with improved on at least one of three outcome measures – aspirin use, blood pressure control, and smoking cessation counseling – or practice change capacity, measured by the Change Process Capability Questionnaire. Less effective facilitators had 50% or fewer of their practices show improvements.

Measuring effectiveness

The researchers found professional background and experience did not distinguish between more and less effective facilitators because both groups had relevant work experience.

“In contrast, several strategies for supporting practice change differentiated between more and less effective facilitators across the cooperatives,” the study said.

The more effective facilitators:

• Cultivated motivation by tailoring quality improvement work to practices’ experience, needs, and preferences, and being flexible. Less effective facilitators “described rigidity in their approach” and were less adept at using motivation to customize practice changes.
• Addressed resistance directly, a trait that “was a notable differentiator” between more effective facilitators who focused on identifying and minimizing barriers to change, and less effective facilitators who described their role as providing education without guiding a plan.
• Created an agenda, provided reminders, set goals, and tracked progress. Some less effective facilitators did not hold meetings, but emphasized being available for consultation, which limited the structure or accountability for change.
• Articulated how they help practices make improvements. That was “a somewhat unexpected” finding, but could be important for those recruiting or hiring facilitators or for practice leaders deciding to work with a particular facilitator.

EHR efficiencies

The researchers noted a subset of more and less effective facilitators focused on changing documentation and electronic health records (EHR) to be more efficient. That generally involved moving data about aspirin use and smoking cessation counseling to appropriate locations in EHR.

“Although this strategy did not require clinical or process changes, it often led to an immediate improvement in outcome,” the study said.

“Effective Facilitator Strategies for Supporting Primary Care Practice Change: A Mixed Methods Study” was published Sept. 26, 2022, in the Annals of Family Medicine, the journal of the American Academy of Family Physicians.