1. Data Analysis: Exploring Facilitator Impact during a Quality Improvement Process Eric K. Shaw, PhD 1 ; J. Anna Looney, PhD 1 ; Sabrina Chase, PhD 1 ; Brian Stello, MD 2 ; Rohini Navalekar, MA 1 ; Benjamin Crabtree, PhD 1 Many quality improvement (QI) efforts use external facilitators as change agents Research has tended to promote a linear understanding of facilitating group development Context: Funded by: National Heart, Lung, & Blood Institute R01 HL70800-01 1 UMDNJ-RWJMS; 2 Lehigh Valley Hospital 6 NJ & PA practices participating in a 12-week QI intervention for the ULTRA study (Using Learning Teams for Reflective Adaptation) All audio-recordings were transcribed Analysis team used an iterative process to develop key areas of facilitator impact and their definitions Coded each category for each meeting using a 5- point scale (4 = “Very High” facilitator impact; 3 = “High”; 2 = “Moderate”; 1 = “Low”; 0 = “None”) Setting & Methods: Facilitators are doing multiple activities at multiple points in time Facilitators must constantly gauge team dynamics and make decisions in the moment about when and how to act and react Suggests that facilitating QI efforts does not follow a linear progression of team development/performance Not just anyone can do it: facilitation requires a unique skill set that includes experience with facilitation tools/techniques and understanding of group process Conclusions: To conduct an in-depth analysis of “facilitator impact” during a quality improvement process To test the assumptions of a linear progression of facilitation and group development Objectives: Process: meeting management and team composition Reflection: prompting team to step back and look at issues; learning current processes; evaluating meetings Relationships: managing conflict; creating a safe place; using humor; using encouragement and + reinforcement Task ID/Completion: directing/re-directing the team to stay on task; establishing accountability; facilitating the delegation of responsibility; setting timelines Codes & Definitions of Facilitator Impact: Results: (During the 1 st QI meeting at Practice “A”, as the facilitator prompted the team to reflect on the practice mission and vision, an intense discussion about trust emerges): Team member 1 : “…the doctors make decisions without realizing how it impacts the front desk…” Team member 2 : “But how can we communicate if we don’t feel comfortable communicating with them…” Facilitator starts to interject: “This might be something…” but gets interrupted by a team member who says “there’s no comfort zone!” Dr A: “…I mean I feel like I eat lunch right here, why aren’t people talking to me… It’s like you guys think I don’t trust you and it’s (pause) basically true…” (Towards the end of the meeting): Facilitator: “Let me interrupt, we have 5 minutes… I just wanted to say I thought you all were very open and honest and courageous. I mean these are difficult things to talk about…” Illustration of Multiple Facets of Facilitation: Overall, facilitators’ impact on process is high at outset and lessens over time Facilitators’ impact on task id/completion peaks around the middle of the intervention Facilitators’ impact on reflection and relationships remains fairly constant over time