Change facilitation for the implementation of innovation in healthcare practice

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𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱: Implementation of innovations in healthcare is complex and multi- dimensional. An intervention that is used in healthcare is change facilitation. There is, however, a lack of frameworks specific to change facilitation, evidence into the strategies conducted by Change Facilitators (CFs) and their effectiveness. In addition, there is a gap in the literature regarding frameworks that combine diagnosis of barriers, prescribing of strategies, and evaluation of effectiveness. 𝗠𝗲𝘁𝗵𝗼𝗱𝘀: This research involved four phases. Phase one was a systematic review of randomised controlled trials following the Cochrane handbook and PRISMA guidelines. Phase two was a mixed method study of a two-year implementation program in community pharmacy involving qualitative input by CFs of the barriers and facilitation strategies identified during the study, and quantitative analysis using a machine learning approach to predict the effectiveness of facilitation strategies in overcoming the barriers. Phase three was an effectiveness-implementation hybrid study during a Minor Ailments Service (MAS) study in community pharmacy aimed at evaluating the effectiveness of a tailored change facilitation intervention using findings from the mixed method study in phase two. Statistical analysis was conducted to determine the resolution percentage of change facilitation categories and longitudinal analysis was conducted to determine the effectiveness of the change facilitation intervention. Phase four brings together the findings from phases one, two, and three, and proposes a change facilitation framework. 𝗥𝗲𝘀𝘂𝗹𝘁𝘀: Phase 1 presents 51 change facilitation strategies captured from the literature, including common strategies in studies reporting positive outcomes. Phase 2 presents a link between 36 barriers identified during the two-year implementation study, and a prediction of the most effective facilitation strategies to overcome the barriers. Phase 3 presents the evaluation of a tailored change facilitation approach, resulting in CFs identifying 67% of implementation barriers in the first two monthly visits and overcoming 75% of these barriers in the same visits. Phase 4 proposes the 6E Change Facilitation Framework for CFs as a dynamic, non-linear approach allowing CFs to explore barriers, tailor their strategies, evaluate their progress, while ensuring adoption by stakeholders. 𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻: Change facilitation is an effective intervention for the implementation of innovation in healthcare. A tailored change facilitation approach according to existing barriers is effective in early identification and resolution of implementation barriers in community pharmacy. The 6E Change Facilitation Framework provides a guiding structure for CFs to tailor their interventions and move dynamically through the implementation and adoption of innovations in healthcare and beyond.
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