Practice Facilitation Handbook
Module 10. Academic Detailing as a Quality Improvement Tool
Academic detailing is peer-to-peer educational outreach. Academic detailing has its roots in pharmaceutical detailing and was designed to improve prescribing practices by physicians. The peer-to-peer format of these commercially oriented encounters has now been adapted for use in improving care quality, as well as to build priority for change in clinicians and leadership.
The goals of academic detailing have traditionally been to improve clinical practice in a targeted area, usually one involving patient care. The National Resource Center for Academic Detailing trains physicians interested in becoming academic detailers, and several States have implemented academic detailing programs to improve patient safety and quality of care.
Academic detailing sessions are not limited to physicians. They can involve peer-to-peer exchanges in any discipline. You may opt to convene academic detailing sessions for chief executive officers, clinical managers, nurses, medical assistants, health educators, chief financial officers, and others to support transformation work taking place at a practice. For example, an expert nurse care coordinator could deliver academic detailing support to another nurse beginning the same activity to improve his or her performance.
These peer-to-peer visits help build leadership’s buy-in to the proposed practice changes and help them understand the role of practice facilitators, what they can and cannot do, and how they can help practices implement these changes. Practice staff are more likely to accept a message if it comes from someone with their same background.
At the beginning of a facilitation intervention, an academic detailer can legitimize the practice facilitator and accelerate development of trust between the practice facilitator and the practice. An academic detailer can also serve as a role model, someone who has gone through the same process and managed to make improvements in his or her practice. This shows the practice that it can be done, that barriers can be overcome.
You can’t start too early. As noted in Module 13, an academic detailer can be an asset at the kickoff meeting. Additional academic detailing sessions can be held during the facilitation intervention as needed to support clinical and other types of changes. You can also use them when you run into roadblocks to progress. The detailer can help “shake things loose” in the practice and provide an additional perspective on the project.
Be judicious, however, in calling on your detailers. They are busy people taking time out of their own duties to help others improve quality of care. Make sure you schedule meetings at times that are convenient to them. By the same token, detailing visits should not last too long. Generally, an hour is sufficient. Although an in-person visit is preferable, consider telephone or video conferencing as an alternative, especially if it is an encore performance.
You will need to identify physicians and others willing to serve as academic detailers for your practices. An ideal detailer will:
- Have experience in the changes you will be supporting at the practice.
- Have experience working with a practice facilitator.
- Have experience being a detailer.
- Be approachable.
- Be a clear communicator with effective educational techniques.
- Have credibility in the community.
- Be an innovative thinker.
- Be empathetic.
If you cannot find a detailer to fit the bill, try asking:
- Your program director.
- Other facilitators—find out whom they work with.
- The practices you facilitate—find out whom they look up to.
- Professional associations.
You can also keep an eye out for speakers at conferences or webinars. Even if you don’t need a particular area of expertise, keep track of particularly skilled speakers for future reference.
Before they meet the practice, brief your detailers to the practice and its goals for facilitation and quality improvement. If your detailer has not been trained and has not been a detailer before, provide him or her some guidance before the first encounter. Ask your detailer to:
- Prepare a few key messages before the session.
- Tell stories. Paint a picture of what it was like in his or her practice.
- Be open to questions.
- Be honest. Don’t minimize the challenges, but show the practice how they can be overcome.
- Be patient. Sometimes it takes practices a while to figure out what they want to know.
Ideally, the visit takes place with the quality improvement team. At times, however, only a few, or even a single member, of the practice staff will meet with the detailer. This is most appropriate when the detailer is an expert in a specific process that only involves a few individuals in the practice. But practice change is a team sport; practice members will generally learn something from a detailer even if the subject is not their own.
Once you identify the academic detailer, ask the leader of the quality improvement team to convene the team to participate in the session. You will facilitate the meeting. Regardless of the detailer’s degree or experience, remember that you are the head of the facilitation team and the primary point of contact with the practice. The work you request from the detailer should support the work in which you are already engaged or are preparing to engage with the practice.
Shortly after the detailer’s visit, debrief with the practice. Find out what they learned and how they might apply this new knowledge to their practice. Expect to hear, “We can’t do that here.” Help them think through adaptations that would make it work. Focus them on the assets of their practice and encourage them to think outside the box.
In summary, consider using the following steps in working with an academic detailer:
- Identify the detailer.
- Orient the detailer to the improvement project and goals and his or her role in peer-to-peer exchange to create buy-in and increase knowledge.
- Decide who should participate in an academic detailing visit.
- Remain the point person/primary point of contact with the practice.
- Listen to the encounters with the detailer and support translation of learning/ideas generated into practice by the quality improvement team.