title: The role of the practice facilitators in Ontario primary healthcare quality improvement.
abstract: BACKGROUND
  Practice facilitation is a key component of quality improvement in primary healthcare. Studies have reported the effectiveness of practice facilitation in improving quality management and care delivery. However, little has been published about practice facilitators' training, facilitation activities, and their perceived role in quality improvement in primary healthcare. This study examined practice facilitators' training and the perceptions of the practice facilitator role in a provincial primary healthcare learning collaborative quality improvement initiative in Ontario, Canada.
  
  
  METHODS
  Descriptive and qualitative methods were used to outline the practice facilitator training as well as to look into the experiences and perceptions of practice facilitators and primary healthcare teams regarding the practice facilitation role in quality improvement. Data collection included training artifacts, activity logs, self-reflection reports, and semi-structured interviews with practice facilitators and primary healthcare participants. Reflections and interviews were analyzed to identify the role of the practice facilitators from their own experience, and from the perspective of the participants. Descriptive statistics were used to learn about categories of facilitation activities undertaken and frequency of these activities.
  
  
  RESULTS
  Sixteen practice facilitators and seven family healthcare teams participated in the study. Practice facilitators received a two-day intensive training workshop and continued training. Their time was spent mostly working directly with participating teams, continued learning and training, communications and administration. They served as coaches, resource providers, enablers and motivators. Participating teams expressed satisfaction with the practice facilitator role, although they had hoped this position would provide onsite and hands-on support in conducting activities of quality improvement at the practice level.
  
  
  CONCLUSIONS
  Practice facilitators played a crucial role in the implementation of quality improvement in Ontario's learning collaborative program. The practice facilitator role is perceived to be that of a coach, enabler and motivator. This study suggests that the practice facilitator successfully supported participating teams to undertake quality improvement activities in primary healthcare settings.
authors.affiliation: Department of Family Medicine, Centre for Studies in Primary Care, School of Medicine, Queen's University, 220 Bagot Street, P.O. Bag 8888, Kingston, Ontario, K7L 5E9, Canada. Jyoti.kotecha@dfm.queensu.ca.
authors.forename: Jyoti
authors.initials: J
authors.lastname: Kotecha
authors.affiliation: Department of Family Medicine, Centre for Studies in Primary Care, School of Medicine, Queen's University, 220 Bagot Street, P.O. Bag 8888, Kingston, Ontario, K7L 5E9, Canada. han.han@dfm.queensu.ca.
authors.forename: Han
authors.initials: H
authors.lastname: Han
authors.affiliation: Department of Family Medicine, Centre for Studies in Primary Care, School of Medicine, Queen's University, 220 Bagot Street, P.O. Bag 8888, Kingston, Ontario, K7L 5E9, Canada. michael.green@dfm.queensu.ca.
authors.forename: Michael
authors.initials: M
authors.lastname: Green
authors.affiliation: Southern Academic Primary Care Research Unit, School of Primary HealthCare, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia. grant.russell@monash.eduMonash.
authors.forename: Grant
authors.initials: G
authors.lastname: Russell
authors.affiliation: Department of Family Medicine, Centre for Studies in Primary Care, School of Medicine, Queen's University, 220 Bagot Street, P.O. Bag 8888, Kingston, Ontario, K7L 5E9, Canada. mary.martin@dfm.queensu.ca.
authors.forename: Mary I
authors.initials: MI
authors.lastname: Martin
authors.affiliation: Department of Family Medicine, Centre for Studies in Primary Care, School of Medicine, Queen's University, 220 Bagot Street, P.O. Bag 8888, Kingston, Ontario, K7L 5E9, Canada. richard.birtwhistle@dfm.queensu.ca.
authors.forename: Richard
authors.initials: R
authors.lastname: Birtwhistle
mesh_terms: D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D003695:Delivery of Health Care / Q000458:organization & administration*; D006801:Humans; D009864:Ontario; D010348:Patient Care Team / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D024382:Professional Role; D036301:Qualitative Research; D058996:Quality Improvement / Q000458:organization & administration*