The implementation of practice facilitators in primary care settings without university affiliation in Quebec, a case study

Abstract

Practice facilitators were integrated into Quebec’s university primary care settings. These facilitators play a key role in the quality improvement culture. Following the evaluation of the contribution of the practice facilitators in this type of primary care setting, a 1-year pilot project was conducted in one of Quebec’s administrative regions. This study examined the implementation process of the practice facilitators in primary care settings without university affiliation.

This study was conducted as a descriptive embedded case study, thereby allowing the consideration of the implementation process in each of the region’s 4 sub-territory. Qualitative methods were used to assess the perception of the practice facilitators’ role and contribution, the governance characteristics and the effect of the COVID-19 pandemic’s context on their integration. Data collection included reports, organizational charts, job posting and semi-structured interviews with practice facilitators, managers and physicians. The Conceptual Framework for Implementation Research (Damschroder, 2009) was used for data collection and analysis. As a collaborative research, preliminary results were presented to a committee twice.

19 semi-structured interviews were conducted with 5 practice facilitators, 7 managers, 1 practice facilitator in a university family medicine group and 6 physicians. Unanimously, the perception of the role of the practice facilitators of all the stakeholders was seen as positive on the qualitative improvement culture and the implementation process of primary care projects. Being decentralized, the practice facilitators can respond in a better and personalized way to each of their sub-territory needs. Thus, improving the relations they have with the primary care settings. Co-management was seen as an important characteristic to facilitate the integration and the perception of practice facilitators. The COVID-19 pandemic’s context served as a lever for the integration of practice facilitators and their collaboration with members of the primary care settings.

The implementation of practice facilitators was positive. Acting as facilitator, change and project managers, these professionals play a key role in the improvement of quality culture, management practices and primary care. This study suggested important components to consider in the implementation of practice facilitators in primary care settings without university affiliation.