title: Facilitating large-scale implementation of evidence based health care: insider accounts from a co-operative inquiry.
abstract: BACKGROUND
  Facilitators are known to be influential in the implementation of evidence-based health care (EBHC). However, little evidence exists on what it is that they do to support the implementation process. This research reports on how knowledge transfer associates (KTAs) working as part of the UK National Institute for Health Research 'Collaboration for Leadership in Applied Health Research and Care' for Greater Manchester (GM CLAHRC) facilitated the implementation of EBHC across several commissioning and provider health care agencies.
  
  
  METHODS
  A prospective co-operative inquiry with eight KTAs was carried out comprising of 11 regular group meetings where they reflected critically on their experiences. Twenty interviews were also conducted with other members of the GM CLAHRC Implementation Team to gain their perspectives of the KTAs facilitation role and process.
  
  
  RESULTS
  There were four phases to the facilitation of EBHC on a large scale: (1) Assisting with the decision on what EBHC to implement, in this phase, KTAs pulled together people and disparate strands of information to facilitate a decision on which EBHC should be implemented; (2) Planning of the implementation of EBHC, in which KTAs spent time gathering additional information and going between key people to plan the implementation; (3) Coordinating and implementing EBHC when KTAs recruited general practices and people for the implementation of EBHC; and (4) Evaluating the EBHC which required the KTAs to set up (new) systems to gather data for analysis. Over time, the KTAs demonstrated growing confidence and skills in aspects of facilitation: research, interpersonal communication, project management and change management skills.
  
  
  CONCLUSIONS
  The findings provide prospective empirical data on the large scale implementation of EBHC in primary care and community based organisations focusing on resources and processes involved. Detailed evidence shows facilitation is context dependent and that 'one size does not fits all'. Co-operative inquiry was a useful method to enhance KTAs learning. The evidence shows that facilitators need tailored support and education, during the process of implementation to provide them with a well-rounded skill-set. Our study was not designed to demonstrate how facilitators contribute to patient health outcomes thus further prospective research is required.
authors.affiliation: School of Nursing, Midwifery and Social Work, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK. Heather.waterman@manchester.ac.uk.
authors.forename: Heather
authors.initials: H
authors.lastname: Waterman
authors.affiliation: Manchester Business School, University of Manchester, Booth St. West, Manchester, M15 6 PB, UK. ruth.boaden@mbs.ac.uk.
authors.forename: Ruth
authors.initials: R
authors.lastname: Boaden
authors.affiliation: CLAHRC, 3rd Floor Mayo Building, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK. Lorraine.burey@srft.nhs.uk.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Burey
authors.affiliation: Advancing Quality Alliance, Salford Royal NHS Foundation trust, Stott Lane, Salford, M6 8HD, UK. Brook.Butler@srft.nhs.uk.
authors.forename: Brook
authors.initials: B
authors.lastname: Howells
authors.affiliation: Manchester Business School, University of Manchester, Booth St. West, Manchester, M15 6 PB, UK. gill.harvey@mbs.ac.uk.|School of Nursing, University of Adelaide, Adelaide, Australia. gill.harvey@mbs.ac.uk.
authors.forename: Gill
authors.initials: G
authors.lastname: Harvey
authors.affiliation: CLAHRC, 3rd Floor Mayo Building, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK. john.humphreys@srft.nhs.uk.
authors.forename: John
authors.initials: J
authors.lastname: Humphreys
authors.affiliation: CLAHRC, 3rd Floor Mayo Building, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK. katy.rothwell@nhs.net.
authors.forename: Katy
authors.initials: K
authors.lastname: Rothwell
authors.affiliation: CLAHRC, 3rd Floor Mayo Building, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK. Michael.spence@srft.nhs.uk.
authors.forename: Michael
authors.initials: M
authors.lastname: Spence
mesh_terms: D003299:Cooperative Behavior; D003695:Delivery of Health Care; D004059:Diffusion of Innovation; D055317:Evidence-Based Practice; D019983:Guideline Adherence; D006302:Health Services Research / Q000379:methods; D006801:Humans; D007407:Interviews as Topic; D007857:Leadership; D011320:Primary Health Care; D011446:Prospective Studies; D036301:Qualitative Research; D012108:Research Personnel; D006113:United Kingdom