title: Implementation of Safe Patient Handling in the U.S. Veterans Health System: A Qualitative Study of Internal Facilitators' Perceptions.
abstract: BACKGROUND
  Although the literature has noted the positive effects of facilitation in implementation research, little is known about what facilitators do or how they increase adoption of a program. The purpose of this study was to understand internal facilitation activities in implementing a national safe patient handling program from the perspective of facility coordinators who implemented the program.
  
  
  METHODS
  Using a qualitative descriptive design, data were collected in five focus groups at two international Safe Patient Handling and Mobility Conferences. Participants were 38 facility coordinators implementing a safe patient handling program in the Department of Veterans Affairs medical centers throughout the United States. Data were analyzed using direct content analysis to gather descriptions of internal facilitation.
  
  
  RESULTS
  The internal facilitation process involved engaging multiple disciplines and levels of leadership for implementation. Fifty-four facilitation activities were identified, including five activities not currently listed in an existing taxonomy. Key characteristics and skills of facilitators included persistence, credibility and clinical experience, and leadership and project management experience. Themes were mapped onto an existing framework and taxonomy of facilitation activities.
  
  
  CONCLUSIONS
  Internal facilitation is both an implementation intervention and a process involving a wide range of activities. The findings provide an understanding of what internal facilitators are doing to support practice changes and the characteristics and skills of internal facilitators that are likely to result in long-term organizational change. Five recommendations for action address organizations, senior leaders, and internal facilitators.
authors.affiliation: Associate Professor, The University of North Carolina at Charlotte, Charlotte, NC.|Research Associate, Health Services Research and Development Center of Innovation for Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans Hospital, Tampa, FL.
authors.forename: C A
authors.initials: CA
authors.lastname: Elnitsky
authors.affiliation: Co-Director, Health Services Research and Development Center of Innovation for Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans Hospital, Tampa, FL.
authors.forename: G
authors.initials: G
authors.lastname: Powell-Cope
authors.affiliation: Qualitative Researcher, Health Services Research and Development Center of Innovation for Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans Hospital, Tampa, FL.
authors.forename: K L
authors.initials: KL
authors.lastname: Besterman-Dahan
authors.affiliation: Health Science Specialist, Health Services Research and Development Center of Innovation for Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans Hospital, Tampa, FL.
authors.forename: D
authors.initials: D
authors.lastname: Rugs
authors.affiliation: Health Science Specialist, Department of Veterans Affairs, Spinal Cord Injury and Disorders Services, VA Puget Sound Healthcare System, and Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
authors.forename: P M
authors.initials: PM
authors.lastname: Ullrich
mesh_terms: D002983:Clinical Competence; D055317:Evidence-Based Practice; D017144:Focus Groups; D019983:Guideline Adherence; D006787:Hospitals, Veterans / Q000592:standards*; D006801:Humans; D055805:Moving and Lifting Patients / Q000592:standards*; D010465:Perception; D036301:Qualitative Research; D014481:United States
keywords: care delivery system; evidence-based practice; facilitation; facilitator; focus group; implementation; nursing practice; qualitative methodology