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Table 5 Examples of how and why the expert facilitator tailored the skills transfer process

From: From novice to expert: methods for transferring implementation facilitation skills to improve healthcare delivery

How the expert tailored her efforts

Why the expert may have tailored her efforts

Focused on helping Trainee-A develop leading and managing team process skills at a High Moderate level (compared to Low level with Trainee-C, who had this skillset); modeled how to lead/manage team processes; coached Trainee-A before, during and after meetings; led meetings when Trainee-A was not ready; stepped in and out when she needed help, and encouraged her to take on this new role.

− Trainee-A had little experience leading task-oriented meetings.

− Trainee-A’s interpersonal style was thoughtful and laid back; she was inclined to be indecisive in meetings with stakeholders.

− Site leaders and staff had strong personalities and expressed opinions forcefully.

Focused on helping Trainee-A learn training, mentoring, and coaching skills at a Low Moderate level (compared to Low level with Trainee-C); coached Trainee-A on using an enforcer role and enlisted Trainee-C to help Trainee-A learn the needed skills.

− Trainee-A was inclined to use a gentle coaching style with PCMHI providers.

− The expert was concerned that this style was unlikely to motivate providers resistant to change or struggling with changing from traditional mental health to PCMHI.

Focused on helping Trainee-A learn education and marketing skills at a High Moderate level (compared to Moderate with Trainee-C).

− Network A had existing infrastructure support for a model of PCMHI that was not compliant with national requirements.

− Network and clinic leaders and providers lacked perceived need to change.

Focused more in the first year on helping Trainee-A learn facilitation skills compared to Trainee-C and considerably more in the second year.

− Trainee-A was young, early in her career, less confident, and tended to rely on the expert even when she no longer needed the her.

− Trainee-C became comfortable with her new role and began acting independently far sooner than Trainee-A.

Targeted Trainee-A’s clinical skills and “translated” them to organizations by comparing facilitation activities to clinical assessment and intervention.

− Trainee-A was an adept mental health provider and therapist.

Supported Trainee-C’s “natural aptitude” for working at the system level; viewed this style as valuable though different from her own.

− Trainee-C had clinical training and extensive experience in program QI and system redesign efforts; she was inclined to address system level issues, e.g., she focused more than Trainee-A on developing trainings and conferences.

− Network C lacked infrastructure support for PCMHI.

Focused on helping Trainee-C learn (1) how to interact and work with leaders at a High level compared to focusing at a Low level with Trainee-A; (2) political skills at a Low Moderate level with Trainee-C and a Low level with Trainee-A; (3) how to engage leaders, assume a leadership role, provide advice and consultation, and interact with leaders comfortably.

− Trainee-C had previous experience in program management and quality improvement but within hierarchical systems under the operational authority of leaders and thus was inclined to defer to them.

− Trainee-C had difficulty engaging VAMC leaders to support implementation.

Focused on helping to motivate stakeholders and build their confidence at a Moderate level with Trainee-C and at a Low level with Trainee-A. She worked with Trainee-C to develop a more positive attitude toward stakeholders and modeled how to interact with them from a strength perspective, e.g., by praising them for what they were able to accomplish.

− Trainee-C’s communication style was direct and somewhat abrupt; she tended to focus on negatives when providing feedback to stakeholders on implementation progress.

− The expert was concerned that Trainee-C’s interpersonal style could be a barrier to engaging stakeholders and fostering PCMHI adoption.