IMPLEMENTATION FACILITATION TRAINING MANUAL

1 IMPLEMENTATION FACILITATIONTRAINING MANUAL Using IMPLEMENTATION FACILITATION to Improve Care in the Veterans Health Administration Version 2 May 18, 2017 Authorship and Acknowledgement IF TRAINING MANUAL Revisions Workgroup Chair and Corresponding author: Mona J. Ritchie, PhD, MSW Quality Enhancement Research Initiative (QUERI) for Team-based Behavioral Health Central Arkansas Veterans Healthcare System Department of Psychiatry, University of Arkansas for Medical Sciences _____ Katherine M. Dollar, PhD VA Center for Integrated Healthcare (CIH) VA Connecticut Healthcare System Christopher J. Miller, PhD Center for Healthcare Organization and IMPLEMENTATION Research (CHOIR) VA Boston Healthcare System Department of Psychiatry, Harvard Medical School Karen A.

2 Oliver, PhD Mental Health Service Line, William S. Middleton Veterans Hospital Department of Industrial Engineering and Systems Engineering, University of Wisconsin Jeffrey L. Smith Quality Enhancement Research Initiative (QUERI) for Team-based Behavioral Health Central Arkansas Veterans Healthcare System Department of Psychiatry, University of Arkansas for Medical Sciences Jan A. Lindsay, PhD VISN 16 South Central Mental Illness Research, Educational, and Clinical Center (MIRECC) Center for Innovation in Quality, Effectiveness and Safety (IQuESt) Michael E. DeBakey VA Medical Center Baylor College of Medicine JoAnn E.

3 Kirchner, MD Quality Enhancement Research Initiative (QUERI) for Team-based Behavioral Health Central Arkansas Veterans Healthcare System Department of Psychiatry, University of Arkansas for Medical Sciences Acknowledgement Contributing authors (listed alphabetically) Mona AuYoung, PhD, MS, MPH VA Center for Clinical Management Research VA Ann Arbor Healthcare System Jacqueline J. Fickel, PhD Center for the Study of Healthcare Innovation, IMPLEMENTATION and Policy (CSHIIP) VA Greater Los Angeles Healthcare System Lisa K. Kearney, PhD, ABPP VA Center for Integrated Healthcare (CIH) Department of Psychiatry, University of Texas Health Science Center at San Antonio Anne C.

4 Lambert-Kerzner, PhD, MSPH VA Center of Innovation for Veteran-Centered & Value Driven Care VA Eastern Colorado Healthcare System Department of Health Systems, Management and Policy, Colorado School of Public Health Swapandeep Mushiana, MS VA National Center for PTSD, Dissemination and TRAINING Division VA Palo Alto Healthcare System Department of Clinical Psychology, University of San Francisco Lindsey E. Zimmerman, PhD VA National Center for PTSD, Dissemination and TRAINING Division VA Palo Alto Healthcare System Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine Special thanks to: Special thanks to our operational partners in the Office of Mental Health Operations for the use of their materials in this MANUAL .

5 We also thank Robin Smith, PhD, for her editorial role in the production of the MANUAL . Support for the project came from: Quality Enhancement Research Initiative (QUERI) for Team-based Behavioral Health at Central Arkansas Veterans Healthcare System, North Little Rock, AR VA Center for Integrated Healthcare at the Syracuse and Buffalo VA Medical Centers Suggested citation: Ritchie MJ, Dollar KM, Miller CJ, Oliver KA, Smith JL, Lindsay JA, Kirchner JE. Using IMPLEMENTATION FACILITATION to Improve Care in the Veterans Health Administration (Version 2). Veterans Health Administration, Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, 2017.

6 Available at: Questions, comments, concerns may be addressed to: Mona J. Ritchie, PhD, MSW QUERI for Team-based Behavioral Health Department of Veterans Affairs 2800 Fort Roots Drive, Building 58, North Little Rock, AR 72114 Phone: 501-257-1735 TABLE OF CONTENTS Introduction to the TRAINING MANUAL .. 1 Section I Introduction to IMPLEMENTATION FACILITATION Chapter 1 - Overview of IMPLEMENTATION FACILITATION .. 4 Chapter 2 - FACILITATION 9 I. IMPLEMENTATION Facilitator Roles .. 9 II. How External Facilitators can Work with Internal Facilitators, Champions, and QI Teams ..15 Chapter 3 - Knowledge, Skills, Core Competencies, and Characteristics of I.

7 Knowledge and Skills ..18 II. Core Competencies ..19 III. Characteristics or Attributes of Facilitators ..20 Section II IMPLEMENTATION FACILITATION Activities Chapter 4 - Phases of IMPLEMENTATION and the IMPLEMENTATION FACILITATION Process ..21 Chapter 5 - IMPLEMENTATION FACILITATION Activities in the Pre- IMPLEMENTATION Phase ..24 I. Introduction ..24 II. Critical Knowledge Prior to IMPLEMENTATION ..24 III. Stakeholder Engagement during the Pre- IMPLEMENTATION Phase ..25 IV. Assessing the Site ..34 V. Hiring and TRAINING Staff ..39 VI. Marketing ..42 VII. The Site Visit: Preparation for Transitioning to the IMPLEMENTATION Phase.

8 44 VIII. Crafting the IMPLEMENTATION Plan: Transitioning to the IMPLEMENTATION Phase ..53 Chapter 6 - IMPLEMENTATION FACILITATION Activities in the IMPLEMENTATION Phase ..56 I. Introduction to the IMPLEMENTATION Phase ..56 II. Stakeholder Engagement during the IMPLEMENTATION Phase ..56 III. Fostering Collaborations during the IMPLEMENTATION Phase ..59 IV. Planning IMPLEMENTATION Team Meetings ..59 V. Facilitating IMPLEMENTATION Meetings ..60 VI. Assessing the Site during the IMPLEMENTATION Phase ..62 VII. Assessing and Monitoring Innovation IMPLEMENTATION ..63 Innovation IMPLEMENTATION ..68 IX. Problem Identification and Resolution.

9 76 X. Building Learning Collaboratives/Communities of Practice ..76 Chapter 7 - IMPLEMENTATION FACILITATION Activities to Support Sustainment of the Clinical Innovation ..78 I. Introduction: ..78 II. Empowering Staff to Sustain the Innovation: Pre- IMPLEMENTATION and IMPLEMENTATION Phase Activities ..79 III. Preparing for Sustainability during the IMPLEMENTATION Phase ..80 IV. IMPLEMENTATION FACILITATION Activities during the Sustainability Phase ..83 Chapter 8 - Virtual IMPLEMENTATION FACILITATION ..86 I. Definition of Virtual IMPLEMENTATION FACILITATION ..86 II. Potential Advantages and Disadvantages of Virtual FACILITATION .

10 86 III. Best Practices and Recommendations ..88 Chapter 9 - Evaluation of the IMPLEMENTATION FACILITATION Strategy ..94 I. Documenting FACILITATION Time and Activities ..94 II. Assessing Fidelity to the Clinical III. Assessing Fidelity to the IMPLEMENTATION FACILITATION Strategy .. 100 IV. Assessing Outcomes .. 101 References .. 104 Appendices: Table of Contents .. 110 Appendix A. Glossaries .. 111 Appendix B. Outline of Initial FACILITATION Call with Mental Health Leadership .. 119 Appendix C. Site Visit Resources .. 122 Appendix E. IMPLEMENTATION Planning Guides .. 139 Appendix F. Clinical Champion Activities & Characteristics.