Sustaining effective quality improvement: building capacity for resilience in the practice facilitator workforce

Practice transformation efforts in healthcare, like the patient-centred medical home model in primary care, have spurred the development of multiple quality improvement (QI) and implementation strategies to support effective change. Nonetheless, uncertainty about how to implement and sustain change in complex healthcare settings1 2 continues to pose significant challenges. Even when practices are receptive,3 limited QI expertise, constrained resources,4 and associated staff morale and burnout5 can impact success. Although efforts among clinicians to improve primary care by embracing a culture of QI continue,6 healthcare systems are increasingly hiring additional personnel, like practice facilitators, with key performance improvement skills to promote and support change.7 However skilled, practice facilitators cannot implement change alone. Their primary function is to enable transformation by activating the healthcare context, the innovation being implemented and the actors implementing the innovation towards successful implementation of practice improvements.8 9 Compared with other individuals participating in QI efforts (eg, quality managers), facilitators are typically appointed to their role by the organisation’s leadership, have been formally trained in QI, and have project-specific content knowledge and varying levels of facilitation experience (novice to expert).10–12 Facilitators can be internal or external to the organisation and typically support change by engaging teams in activities like task management, process monitoring, relationship building, motivation and accountability checks,13 14 during inperson or distance-based (phone or video) encounters. Successful facilitators tailor the innovation to the local context, effectively integrate into the team responsible for QI, push through resistance from recipients of the innovation and remain flexible.15 Providing this type of facilitation in a dynamic (and sometimes dysfunctional) context can be emotionally and mentally taxing, with facilitators risking the same work-related stress and emotional exhaustion (burnout) as the healthcare staff they support,16 potentially defeating the purpose of facilitation. …