Research ArticleResearch

Experiences of practice facilitators working on the Improved Delivery of Cardiovascular Care project

Retrospective case study

Clare Liddy, Margo Rowan, Sophie-Claire Valiquette-Tessier, Paul Drosinis, Lois Crowe and William Hogg
Canadian Family Physician January 2018, 64 (1) e23-e32;

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    Inclusion of narrative reports in case study

    IDOCC—Improved Delivery of Cardiovascular Care.

  • Figure 2.
    Figure 2.

    Number and type of barriers and facilitators for site A across the 3 program phases: Indicators are areas that require focus within the practice, and the 5 factors (coloured lines) distinguish where change can occur.

  • Figure 3.
    Figure 3.

    Number and type of barriers and facilitators for site B across the 3 program phases: Indicators are areas that require focus within the practice, and the 5 factors (coloured lines) distinguish where change can occur.

Tables

  • Table 1.

    Constructs affecting implementation of health innovations

    CONSTRUCTSDEFINITIONEXAMPLES OR SUBCONSTRUCTS
    Structural“The outer setting or external structure of the broader sociocultural context or community in which a specific organization is nested”19,22

    • Physical environment (eg, elements that pose barriers to health care access)

    • Political or social climate (eg, liberal vs conservative)

    • Public policies (eg, laws governing health care practices)

    • Economic climate (eg, funding available)

    • Infrastructure (eg, access to public transportation)

    Organizational“Aspects of the organization in which an innovation is being implemented”19

    • Leadership effectiveness

    • Culture or climate (eg, extent to which an organization values and rewards an innovation)

    • Staff satisfaction or morale

    Provider“Aspects of the [team, practice, or group of providers] who implements the innovation with a patient or client”19

    • Attitude toward evidence-based practice

    • Perceived control to implement an innovation

    Innovation“Aspects of the innovation that will be implemented”19

    • Relative advantage of using an innovation beyond current practices

    • Quality of the evidence supporting the benefit of an innovation

    Patient“Patient characteristics … that can impact implementation outcomes”19,23

    • Health-related beliefs

    • Motivation

    • Personality traits

    • Behavioural risk factors (eg, alcohol misuse)

    • Beliefs and attitudes (eg, trust or mistrust of medical practices)

    • Adapted from Chaudoir et al.19

  • Table 2.

    Most common facilitators and barriers for sites A and B

    CONSTRUCTSCOMMON SUBTHEMES
    Structural

    • Broader community health influences (eg, outbreaks of illnesses)

    • Communication (connecting with providers outside the practice)

    • Community resources related to intervention—facilitators during the planning and sustainability phases*

    • Educational and networking resources related to IDOCC

    • Macro-level economic and political environment (eg, financial resources from government)

    Organizational

    • Change in practice model (eg, to a different type of primary care model)

    • IT and EMR (experiences or beliefs about IT and EMR)—barrier during implementation*

    • Leadership

    • Micro-level financial resources (within the organization)

    • Office efficiency (organization and management)—barrier and facilitator during planning and implementation*

    • Space (characteristics of location or work and office areas)

    • Staff mix (availability and involvement of staff)

    • Time (time available)

    Provider

    • Communication between and among staff

    • Personal and staff functioning as part of a team

    • Provider attitude toward the IDOCC intervention—barrier during implementation and sustainability phases*

    • Roles and responsibilities (clarity and scope of practice)—barrier during planning*

    Innovation

    • Awareness and insight of practice about processes needing adjusting

    • Charting, flow sheets, and template (attitude and experience)—facilitator during implementation*

    • Comprehending, complying, and agreeing with recommendations from IDOCC audit

    • Patient-physician processes (attitude and experience toward these, such as self-management)

    • PF’s capacity to spread learning from another innovation to the site—facilitator during implementation*

    • Reaction of practice to PF’s involvement and advice—facilitator during implementation*

    • Reminder system (attitude and experience)

    Patient

    • Very few patient-level barriers and no patient-level facilitators were identified

    • EMR—electronic medical record, IDOCC—Improved Delivery of Cardiovascular Care, IT—information technology, PF—practice facilitator.

    • ↵* The most common facilitators and barriers identified in ≥ 25% of a given subtheme for either case, noted by program phase.

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Experiences of practice facilitators working on the Improved Delivery of Cardiovascular Care project
Clare Liddy, Margo Rowan, Sophie-Claire Valiquette-Tessier, Paul Drosinis, Lois Crowe, William Hogg
Canadian Family Physician Jan 2018, 64 (1) e23-e32;
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