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Table 1 Implementation facilitation skills, descriptions, and related skills

From: From novice to expert: a qualitative study of implementation facilitation skills

Facilitation skillsDescriptions of skillsSkills that are included
Communication skillsInteracting with individuals and groups, orally or in writing, to share information, e.g., through formal presentations, less formal conversations, emails, messages, and reports; listening to stakeholders; and asking questions to understand their needs and concernsNone
Skill group 1: Building relationships and creating a supportive environment
 Interpersonal skillsInteracting with stakeholders in positive ways, e.g., listening to stakeholders and ensuring they have opportunities to express their opinions, deferring to them when appropriate, working around their schedules, assessing and addressing their needs and concerns, and knowing when and how to be assertive and still be supportiveAssessment, communication
 Stakeholder engagementInvolving stakeholders (individuals/teams that can affect or will be affected by the innovation) and fostering participation in planning and implementation processes, as well as tailoring interactions to their needsAssessment, communication, education and marketing, interpersonal, motivating and building confidence, political
 Motivating/building confidencePraising stakeholders for participation and implementation progress and encouraging them to assess their own efforts, share their successes, solve problems, and create their own strategiesCommunication, interpersonal
 Political skillsAssessing, understanding, navigating, and leveraging the political dynamics of the settingAssessment, communication, interpersonal, problem identification/solving
 Interacting and working with leadersCombining and applying all of the skills in this group to obtain the support and involvement of leaders, includes being comfortable with leadership at all levels, adopting a power stance when appropriate, and being respectful of leaders’ time and supportive of their decisionsCommunication, stakeholder engagement, interpersonal, motivating and building confidence, political, pulling back and disengaging
Skill group 2: Changing the system of care and structures and processes that support it
 Helping to design/adapt a program to meet local needsHelping stakeholders plan a PCMHI program that fits with local needs and available resources and further adapt the program based on implementation progress and outcomes data and emerging barriers and enablersAssessment, communication, interpersonal, leading and managing team processes, presenting and using data, problem identification/solving
 Problem identification and solving skillsIdentifying and addressing problems and helping stakeholders identify and address problems, e.g., lack of space, implementation resources, leadership support, and stakeholder participationAssessment, presenting and using data, stakeholder engagement
 Presenting/using data to improve the programReviewing, interpreting, and presenting qualitative and quantitative information and using this information, e.g., to support and encourage stakeholder efforts, plan interventions to improve implementation, and support problem identificationCommunication, interpersonal, monitoring implementation, stakeholder engagement, thinking strategically and planning
 Helping integrate the program into other programs/servicesIdentifying and collaborating with leaders/staff of programs whose patients might need PCMHI services, who may provide additional services for PCMHI patients, or who may benefit from knowledge of the PCMHI program, to support sustainability after active implementationAssessment, communication, interpersonal, leading and managing team processes, thinking strategically and planning
Skill group 3: Transferring knowledge and skills and creating infrastructure support for ongoing learning
 Education/marketing skillsPersuasively presenting and discussing PCMHI models, how they work, and the evidence for them; their value, benefits, and outcomes; and how to implement them, including how to address implementation challenges, as well as tailoring content and process to stakeholder needs and concernsAssessment, communication, interpersonal
 Training, mentoring, and coaching skillsUsing training, mentoring, and coaching techniques to transfer skills to clinicians and leaders for providing PCMHI services, e.g., for delivering evidence-based PCMHI care models, rather than traditional mental healthcare, and increasing the number of PCMHI patientsAssessment, communication, education and marketing, learning and fostering learning, monitoring implementation
 Learning and fostering learning skillsApplying learning strategies (e.g., learning from experts, others similar to yourself, and from past experiences) to fill in gaps in knowledge and build on existing knowledge and skills, and fostering stakeholder use of these strategiesNone
 Building learning collaborativesBuilding a learning collaborative for PCMHI clinicians to support implementation by encouraging participation, facilitating meetings/calls, and encouraging members to share their own experiences and problems, work on solutions, and develop best practicesCommunication, education and marketing, interpersonal, learning and fostering learning, pulling back and disengaging
Skill group 4: Planning and leading change efforts
 Administrative and project management skillsPerforming technical tasks, e.g., working with sites to plan and schedule site visits and conference calls and disseminating materials and site visit reports, and pushing implementation forward when stakeholders/sites were not responding, or implementation processes were stalledInterpersonal, monitoring implementation, political, and problem identification/solving
 Meeting facilities and individuals where they areAccepting and working with site and stakeholder limitations, building on their strengths, and helping them be as successful as possibleInterpersonal
 Leading/managing team processesFacilitating communication and managing conflict/disruptive behavior; guiding team processes, e.g., by sharing ideas, affirming stakeholder input, fostering team self-management; and leading task-oriented processes, e.g., goal setting, program design and adaptation, decision-making, and problem identification and solvingAssessment, communication, interpersonal, problem identification/solving, stakeholder engagement
 Thinking strategically and planningThinking through what was currently happening at sites, what needed to happen for successful implementation, and how facilitators could help; planning/preparing for implementation events; and diagnosing/evaluating sites and implementation processesAdministrative and project management, assessment, monitoring implementation, problem identification/solving
 Pulling back and disengagingGaging when stakeholders are ready to assume responsibility for implementation efforts and refraining from acting as the expert, deferring decision-making to leaders, helping stakeholders explore options and come to consensus, and saying good-byeAssessment, interpersonal
Skill group 5: Assessing people, processes, and outcomes and creating infrastructure for program monitoring
 Organizational and individual assessment skillsGathering information about and assessing the organizational context, including demographics, current practices, leadership structure/support, and relevant policies and procedures that could influence implementation and assessing stakeholders, interpersonal and group dynamics, and other factorsCommunication
 Developing a program monitoring systemHelping sites identify measures for assessing/monitoring provider productivity, program utilization, and outcomes; identifying, accessing, and obtaining data from existing databases; and developing/preparing feedback reports for monitoring, adapting, and improving the programAdministrative and project management, assessment, communication, engaging stakeholders, learning and fostering learning
 Monitoring program implementation statusContinually observing implementation progress by reading and interpreting data in feedback reports; assessing program fidelity to evidence-based care, compliance with VA policy and fit with organizational context; and assessing implementation barriers and enablersAssessment, developing a program monitoring system, problem identification/solving