The purpose of this paper is to advance understanding about the facilitation process used in complex implementation projects, by describing the function of novice clinician facilitators, and the barriers and enablers they experience, while implementing a new model of care for managing hospital malnutrition.
Semi-structured interviews were undertaken with local facilitators (n=7) involved in implementing The SIMPLE Approach (Systematised Interdisciplinary Malnutrition Pathway Implementation and Evaluation) in six hospitals in Queensland, Australia. Facilitator networks and training supported the clinicians acting as novice facilitators.
Key functions of the facilitator role were building relationships and trust; understanding the problem and stimulating change through data; negotiating and implementing the change; and measuring, sharing and reflecting on success. “Dedicated role, time and support” was identified as a theme encompassing the key barriers and enablers to successful facilitation.
When implementing complex interventions within short project timelines, it is critical that novice clinician facilitators are given adequate and protected time within their role, and have access to regular support from peers and experienced facilitators. With these structures in place, facilitators can support iterative improvements through building trust and relationships, co-designing strategies with champions and teams and developing internal capacity for change.
This case study extends the knowledge about how facilitation works in action, the barriers faced by clinicians new to working in facilitator roles, and highlights the need for an adapt-to-fit approach for the facilitation process, as well as the innovation itself.
The authors would like to acknowledge the dedication and enthusiasm of the local facilitators and their teams, as well as the SIMPLE implementation and research steering committees: Dr Merrilyn Banks, A/Prof Tracy Comans, Claire Costello, Jan Hill, Dr Robert O’Sullivan, Dr Christine Slade, Karen Slater, and Kate Smith. This project was supported by funding from the Allied Health Professions Office of Queensland and Australian Centre for Health Service Innovation, with in-kind support provided by Hospital and Health Services districts involved in the project. The funders provided oversight for the implementation and reviewed the research protocol, but had no involvement in data collection, analysis, interpretation or manuscript preparation.
Conflict of interest: Professor Heather Keller holds an endowed chair with the Schlegel-University of Waterloo Research Institute for Aging and is a co- chair of the Canadian Malnutrition Task Force, which receives unrestricted educational grants from industry. She has also been on the speakers’ bureau for Abbott Nutrition, Nestlé Health Sciences and Fresenius Kabi in the past three years. The other authors have no conflicts of interest to disclose.
Young, A.M., Keller, H.H., Barnes, R. and Bell, J.J. (2019), "Clinicians as novice facilitators: a SIMPLE case study", Journal of Health Organization and Management, Vol. 33 No. 1, pp. 78-92. https://doi.org/10.1108/JHOM-03-2018-0071
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