Delivering Primary Care Practice Facilitation

Practice facilitation (also called practice coaching) is a supportive service provided to a primary care practice by a trained individual or team of individuals. The aim is to help practices improve the care they deliver, often by focusing on the implementation of specific evidence-based care or models of care to improve patient outcomes and experiences. A robust body of evidence supports practice facilitation as an effective strategy to improve primary healthcare processes and outcomes through the creation of an ongoing, trusting relationship between an external facilitator and a primary care practice.

This page has resources for practice facilitation programs, practice facilitation training and curricula, and resources for practice facilitators.

Practice Facilitation Training and Curricula

Practice facilitators undertake a wide range of activities, depending on the needs and goals of the practice they are working with. They therefore need a broad set of skills to be successful. AHRQ has created a series of materials to train individuals to become practice facilitators.

• AHRQ Practice Facilitation Training Modules
  These free, interactive training modules introduce some of the basic skills that practice facilitators need. They give new facilitators a solid foundation and give experienced facilitators a refresher on specific people and technical skills.
• AHRQ’s Primary Care Practice Facilitation Curriculum
  AHRQ’s Primary Care Practice Facilitation Curriculum (PCPF) is a comprehensive curriculum designed to be used by practice facilitation program in the training of new practice facilitators. Each of the 32 modules contains a Trainer’s Guide, which includes a checklist of materials, the learning objectives for the session, and a list of readings and activities designed to develop basic knowledge and skills. Individual practice facilitators can also use the PCPF Curriculum for self-study.
• Obtaining and Using Data in Practice: A Handbook for Health IT Advisors and Practice Facilitators
  This handbook provides in-depth information and techniques to help primary care practices use electronic health records and other health IT for quality improvement efforts. The handbook covers the following topics: clinical decision support, patient portals and other technologies, using patient-generated data, clinical quality measures, and risk stratification in primary care. The handbook also features helpful tips, examples, and use cases to support the use of health IT for QI efforts.
• The Practice Facilitation Handbook
  The Practice Facilitation Handbook, a predecessor of the PCPF Curriculum, is now archived. It consists of 21 training modules with guidance for trainers.
• Engaging Primary Care Practices in Quality Improvement: Strategies for Practice Facilitators (PDF, 1 MB)
  This white paper describes approaches practice facilitators can take to engage primary care practices in ongoing quality improvement (QI) activities. It presents a framework for engaging primary care practices in QI and provides practical strategies for gaining initial buy-in from practices, maintaining meaningful and sustained engagement in QI efforts, and working with multiple QI programs.
• Quick-Start Guide: Engaging Primary Care Practices in Quality Improvement: Strategies for Practice Facilitators (PDF, 285 KB)
  This guide distills wisdom and best practices from experts who have honed their approaches through working on QI and practice redesign initiatives with more than 6,000 practices in 44 States.

Resources for Practice Facilitators

Practice Facilitators can find many resources to help practices make changes to build their capacity to engage in quality improvement and implement the best evidence.

• EvidenceNOW Key Driver Diagram
  The EvidenceNOW key driver diagram shows what practices need to do to achieve the aim of successfully translating evidence into improved care. Learn about the six key drivers—big changes that practices make to keep pace with changing evidence—and their associated change strategies—specific actions that support the achievement of that key driver.
• EvidenceNOW’s Resources for Practice Facilitators
  These resources, developed for AHRQ’s EvidenceNOW initiative, are specifically for practice facilitators and quality improvement professionals working with primary care practices. Practice facilitators will also find useful resources in EvidenceNOW Tools for Change, a curated repository of tools to help practices implement the best evidence. You can search Tools for Change by EvidenceNOW key driver, topic, or keyword.
  • Kick-Off Visit Checklist
    This resource presents a checklist to help practice facilitators prepare for, conduct, and follow up after a meeting to kick off a QI project in primary care. 
  • Implementing Heart Health Practice Self-Assessment
    This toolkit is for facilitators to help primary care practices implement the ABCS of heart health and create a supportive practice environment for quality improvement. It contains 15 different checklists and strategies. 
  • Responses to Common Practice Objections to Changes Needed to Implement Evidence
    This resource helps facilitators anticipate the potential objections of primary care practices to making changes to implement evidence. It offers ways to respond and help practices maintain forward momentum on QI efforts.  
  • Quality Improvement Change Assessment (QICA)
    This tool assesses primary care practices’ capacity to make changes needed to implement heart health evidence. The QICA identifies areas for improvement, and when completed at regular intervals, tracks practice transformation progress. 
  • Self-Management Support Strategies for Improving CVD Risk Factors—Practice Engagement!
    This presentation explains key principles of effective self-management support (SMS) and the evidence behind SMS for improving heart health. It also includes strategies to implement SMS throughout primary care practices.  
  • ABCS Toolkit for the Practice Facilitator
    This toolkit introduces the ABCS of heart health and provides checklists, action plans, and other instructions to guide primary care practices to implement evidence-based guidelines, transform health care delivery, and improve patients’ heart health.  
  • Clinic Intervention Tracking Sheet
    This QI intervention tracking sheet helps primary care practices and practice facilitators assess and monitor efforts to improve heart health outcomes. The worksheet can also be adapted for other QI efforts.  
  • Practice Progress Notes Template
    This reporting template can be used by practice facilitators to track progress on goals and measures for QI projects. It can help facilitators plan their own work and keep the primary care practice team focused on QI activities. 

Practice Facilitation Programs

Practice facilitation programs can be run out of universities, quality improvement organizations, State agencies, health plans and systems, or can be freestanding in the community. They employ practice facilitators—specially trained individuals who combine people skills and quality improvement (QI) frameworks and tools to help a practice to make immediate, specific improvements, as well as increase its capacity to engage in improvement activities over time.

The intensity of practice facilitation can vary in terms of the hours spent with the practice as well as the length of time working with a practice. Practice facilitation programs also vary in the balance of time spent physically at the practice site and the amount of remote facilitation (through phone or video conferences and webinars).

AHRQ has many resources for practice facilitation programs, including the following.

• A How-To Guide on Developing and Running a Practice Facilitation Program (PDF, 3 MB) is for organizations interested in starting a practice facilitation program designed to work with primary care practices on quality improvement activities, with an emphasis on primary care redesign and transformation. Organizations or individuals who will develop, design, and administer such programs will benefit from the practical knowledge and hard-won lessons shared in this guide.
• Building Capacity for Primary Care Quality Improvement Briefs describe the need for external infrastructure to help primary care practices develop QI capacity and describe approaches and supports for ongoing QI.
  • Creating Capacity for Improvement in Primary Care: The Case for Developing a Quality Improvement Infrastructure (PDF, 251 KB)
  • Building Quality Improvement Capacity in Primary Care: Supports and Resources (PDF, 1.6 MB)
  • Quality Improvement in Primary Care: External Supports for Practices (PDF, 260 KB)
• Recruitment and Retention of Primary Care Practices in Quality Improvement Initiatives: A Toolkit (PDF, 832 KB) provides guidance, tips, and examples to help make primary care practice recruitment efforts as effective and efficient as possible.
• How a Practice Facilitator Can Support Your Practice (PDF, 111.5 KB) educates primary care practices interested in getting started with quality improvement activities about the benefits of working with a practice facilitator (quality improvement coach).