From Theory to Practice: Conducting Implementation Facilitation Interventions in Clinical Settings

Saturday 1:00 – 2:15 Breakout E2

Presentor: Joann E. Kirchner

JoAnn E. Kirchner, VA Mental Health Quality Enhancement Research Initiative (QUERI),  Central Arkansas Veterans Healthcare System, North Little Rock, AR, Department of Psychiatry, University of Arkansas for Medical Sciences; Jeffrey Smith, VA Mental Health Quality QUERI, Central Arkansas Veterans Healthcare System, North Little Rock, AR



Implementing new practices and sustaining clinical practice change is challenging. Decades of organizational science research and more recent implementation science studies have identified limitations in both top-down mandates and bottom-up approaches to implementing practice change. The Promoting Action on Research Implementation in Health Services (PARIHS) framework suggests that successful implementation is a function of the dynamic interaction between context, evidence and facilitation.  Implementation Facilitation (IF) has shown great promise as a strategy for implementing programs and practices, particularly at locations that would otherwise face significant challenges in conducting quality improvement efforts. IF strategies bundle discrete implementation interventions and focus on building relationships and partnering with clinical and administrative personnel. Facilitators use particular activities and techniques depending on the purpose of facilitation, stakeholder needs and the complexity of the clinical program or practice being implemented. This presentation will provide an overview of implementation facilitation, framed within PARIHS, and describe the development and evaluation of a highly partnered implementation facilitation model used within VHA.


Establishment of a National Practice-Based Implementation Network to Accelerate Adoption of Evidence-Based and Best Practices

Saturday 1:00 – 2:15 Breakout E2

Presentor: Josef Ruzek, Ph.D.

Pearl McGee-Vincent, National Center for PTSD, VA Palo Alto Health Care System; Nancy Liu, National Center for PTSD, VA Palo Alto Health Care System; Robyn Walser, National Center for PTSD, VA Palo Alto Health Care System, UC Berkeley; Jennifer Runnals, Durham VA Medical Center, VISN 6 MIRECC, Duke University School of Medicine; R. Keith Shaw, Associate Director, Clinical, Mid-Atlantic (VISN6) MIRECC, Durham VA Medical Center; Sara Landes, National Center for PTSD, VA Palo Alto Health Care System ; Craig Rosen, National Center for PTSD, VA Palo Alto Health Care System, Stanford University; Janet Schmidt, National Center for PTSD, VA Palo Alto Health Care System; Patrick Calhoun, VA Mid-Atlantic Mental Illness Research Educational & Clinical Center,


Practice-Based Research Networks (PBRNs) are groups of providers and researchers working together to examine health care processes in broad populations of patients and settings in an effort to improve health care outcomes. We adapted this model and developed a Practice-Based Implementation Network in the U.S. Department of Veteran Affairs and Department of Defense. The goal of this national network is to facilitate ongoing and rapid implementation of mental health best practices including the treatment of PTSD. The network uses qualitative and quantitative methodologies to enable the efficient study of factors affecting adoption of practices. We have successfully applied two implementation strategies, technical assistance and external facilitation, with 18 VA clinics (including 151 providers from a range of disciplines) across different settings (e.g., specialty PTSD, general mental health, primary care clinics) in instituting mental health outcomes monitoring.  Information sharing and collaboration among the network sites is facilitated with monthly champion calls, a network website, and activities geared at fostering peer support.  This presentation will describe design, development, and operation of the network, as well as data on characteristics of sites and outcomes of the first practice change.


Facilitation as a Mechanism of Implementation in a Practice-Based Implementation Network: Improving Care in a Veteran’s Affairs PTSD Outpatient Clinic.

Saturday 1:00 – 2:15 Breakout E2

Presentor: Ruth L. Varkovitzky

Ruth L. Varkovitzky, PhD, Staff Psychologist, VA Puget Sound Health Care System – American Lake Division; Assistant Professor, University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences


Facilitation is a problem-solving based method for supporting entities in the process of implementing a practice change.  The purpose of a facilitation strategy is to speed adoption and reduce costs associated with systems change.  Facilitation was the primary implementation process incorporated into the Practice-Based Implementation Network (“PBI Network???) created by the U.S. Department of Veteran Affairs and Department of Defense. The main goal of the first PBI Network project was to assist mental health professionals in adopting outcomes monitoring. In this presentation, we will describe how facilitation functioned within a PTSD Outpatient Clinic in the VA health care system. Step-by-step descriptions of the facilitation process will be described by an on-site EBP champion, responsible for implementation of an outcomes monitoring project within her clinic. The panelist will describe her experience working with facilitators, as well as the process of bringing a clinical team on board to a new project. Lessons learned from implementation barriers will also be shared. The effect of sites’ contextual variables such as workload, resourcing, experience with evidence-based practices, and management style on facilitation strategies will also be discussed.