Dedicated Workforce Required to Support Large-Scale Practice Improvement

Shannon M. Sweeney, Jennifer Hemler, Andrea N. Baron, Tanisha T. Woodson, Sarah S. Ono, Leah Gordon, Benjamin F. Crabtree, Deborah J. Cohen

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


BACKGROUND: Facilitation is an effective approach for helping practices implement sustainable evidence-based practice improvements. Few studies examine the facilitation infrastructure and support needed for large-scale dissemination and implementation initiatives. METHODS: The Agency for Health care Research and Quality funded 7 Cooperatives, each of which worked with over 200 primary care practices to rapidly disseminate and implement improvements in cardiovascular preventive care. The intervention target was to improve primary care practice capacity for quality initiative and the ABCS of cardiovascular disease prevention: aspirin in high-risk individuals, blood pressure control, cholesterol management, and smoking cessation. We identified the organizational elements and infrastructures Cooperatives used to support facilitators by reviewing facilitator logs, online diary data, semistructured interviews with facilitators, and fieldnotes from facilitator observations. We analyzed these data using a coding and sorting process. RESULTS: Each Cooperative partnered with 2 to 16 organizations, piecing together 16 to 35 facilitators, often from other quality improvement projects. Quality assurance strategies included establishing initial and ongoing training, processes to support facilitators, and monitoring to assure consistency and quality. Cooperatives developed facilitator toolkits, implemented initiative-specific training, and developed processes for peer-to-peer learning and support. CONCLUSIONS: Supporting a large-scale facilitation workforce requires creating an infrastructure, including initial training, and ongoing support and monitoring, often borrowing from other ongoing initiatives. Facilitation that recognizes the need to support the vital integrating functions of primary care might be more efficient and effective than this fragmented approach to quality improvement.

Original languageEnglish (US)
Pages (from-to)230-239
Number of pages10
JournalJournal of the American Board of Family Medicine : JABFM
Issue number2
StatePublished - Mar 1 2020

All Science Journal Classification (ASJC) codes

  • Public Health, Environmental and Occupational Health
  • Family Practice


  • Delivery of Health Care
  • Evidence-Based Practice
  • Preventive Health Services
  • Primary Health Care
  • Qualitative Research
  • Quality Improvement


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