title: Developing a facilitation model to promote organisational development in primary care practices.
abstract: BACKGROUND
  The relationship between effective organisation of general practices and health improvement is widely accepted. The Maturity Matrix is an instrument designed to assess organisational development in general practice settings and to stimulate quality improvement. It is undertaken by a practice team with the aid of a facilitator. There is a tradition in the primary care systems in many countries of using practice visitors to educate practice teams about how to improve. However the role of practice visitors as facilitators who enable teams to plan practice-led organisational development using quality improvement instruments is less well understood. The objectives of the study were to develop and explore a facilitation model to support practice teams in stimulating organisational development using a quality improvement instrument called the Maturity Matrix. A qualitative study based on transcript analysis was adopted.
  
  
  METHODS
  A model of facilitation was constructed based on a review of relevant literature. Audio tapes of Maturity Matrix assessment sessions with general practices were transcribed and facilitator skills were compared to the model. The sample consisted of two facilitators working with twelve general practices based in UK primary care.
  
  
  RESULTS
  The facilitation model suggested that four areas describing eighteen skills were important. The four areas are structuring the session, obtaining consensus, handling group dynamics and enabling team learning. Facilitators effectively employed skills associated with the first three areas, but less able to consistently stimulate team learning.
  
  
  CONCLUSIONS
  This study suggests that facilitators need careful preparation for their role and practices need protected time in order to make best use of practice-led quality improvement instruments. The role of practice visitor as a facilitator is becoming important as the need to engender ownership of the quality improvement process by practices increases.
authors.affiliation: Centre For Health Sciences Research, Neuadd Meirionydd, Heath Park, CF14 4YS, Cardiff, UK. RhydderchM@Cardiff.ac.uk
authors.forename: Melody
authors.initials: M
authors.lastname: Rhydderch
authors.forename: Adrian
authors.initials: A
authors.lastname: Edwards
authors.forename: Martin
authors.initials: M
authors.lastname: Marshall
authors.forename: Glyn
authors.initials: G
authors.lastname: Elwyn
authors.forename: Richard
authors.initials: R
authors.lastname: Grol
mesh_terms: D003253:Consultants; D003299:Cooperative Behavior; D005194:Family Practice / Q000458:organization & administration* / Q000592:standards; D006126:Group Processes; D006302:Health Services Research; D006801:Humans; D008332:Management Quality Circles; D017146:Models, Organizational; D017008:Negotiating; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D011361:Professional Competence; D016730:Program Development; D011785:Quality Assurance, Health Care / Q000379:methods / Q000458:organization & administration*; D012932:Social Facilitation; D006113:United Kingdom