Table 4.

Summary of Strategies Used and Articulation of Strategies by More and Less Effective Facilitators

Facilitator EffectivenessCultivating Motivation, Tailoring, and Addressing ResistanceGuiding Practices Though the Change ProcessArticulating Strategies to Help Practices
More effectiveAligned EvidenceNOW work with other payer initiatives or practice goals.
Used formal assessment tools or casual conversations to assess practice readiness to change and QI capacity.
Addressed resistance directly and worked with practice to overcome barriers (eg, suggesting smaller tests of change, working with EHR vendors, helping reallocate tasks among team members).
Identified pain points through conversation with the practice and discussed next steps.
Shared ideas from other practices (cross-pollination) such as on workflows and patient education and helped tailor to the local context to make changes appropriate across diverse practice settings.
Provided project management support (eg, agenda setting, note-taking, summarizing action items, assigning tasks to team members, providing reminders).
Yes—were able to speak in detail about the work they did in specific practices, how this work was tailored, and which changes likely led to improvements.
Less effectiveShowed less evidence of motivating and tailoring.
Cited practice resistance as preventing work from being done. Described not wanting to push the practice too hard.
Held didactic meetings with education alone.
Did the work for the practice.
Presented options for the change process, but did not push the practice to identify their next steps.
Some did not have structured meetings; emphasis was on just being present in the practice.
No—when asked about work done in specific practices, answers were limited to the facilitator’s overall approach and to description of presentations and materials used.
  • EHR = electronic health record; QI = quality improvement.