The themes related to facilitators and barriers that emerged from the analysis of the interviews are summarized in Table 1.
Table 1
Facilitators and barriers to the trainees’ work as Practice Facilitators
Code (Themes) | Definition |
Facilitators |
Practice Facilitator Trainee’s Organization |
Organization support | Facilitator organization protects the time of the facilitator to do the work |
Six BBs Program and the Training Program |
Accountability | Training team keeping facilitators accountable |
Peer group | Peer group to discuss challenges and share good ideas |
Training team availability | Training team readily available to help and answer questions |
In-person training | Valuable time building peer relationships and developing an understanding of the program |
Implementation blueprint | Six Building Blocks Workbooks guided the work step-by-step |
Tools & Resources | Six Building Blocks website held many answers and supportive tools |
Miscellaneous |
Clinical Expert | An external chronic pain clinical advisor to support the practice facilitator in a) answering clinical questions and b) helping clinics understand the importance of the work |
Barriers |
Practice Facilitator Trainee’s Organization |
Isolated | Only quality improvement person in organization working on opioid management |
Missing a clinical expert | No external chronic pain clinical advisor as part of quality improvement team to speak to clinics |
Limited organization support | Facilitator’s organization not supportive of protecting the time it takes to implement the Six Building Blocks program with clinics |
Six BBs Program and the Training Program |
Program too flexible | Work timeline flexibility in the program leads to loss of momentum |
Dwindling peer group | Peer group diminished over time, thus reducing the amount of experiences shared |
Trainee |
Lack of experience | Lack of experience with Six Building Blocks and chronic pain management makes clinic facilitation through the program harder |
Trainees endorsed several themes related to important aspects of the training and support provided. They reported that the in-person training not only provided an understanding of the Six BB program, it was also a valuable opportunity to build peer relationships which subsequently provided a peer support group in the period after the formal in-person training.
…that was a very critical foundational piece where the Six Building Blocks subject matter experts were bringing the practice facilitators together. So I think that was important for relationship building, which leads to ultimate success in a lot of programs.
They also valued the availability of more experienced facilitators who supported and mentored them and then held them accountable during shared learning calls.
…just because of their experience with the curriculum and as facilitators, they know inside and out what the resistance might be related to, if we get stuck or if we're having a challenge.
They also mentioned the importance of providing helpful tools and resources (e.g., website, workbooks, skills training).
There were so many times I was like ‘hey, check out this website, a lot of information is on there and it's so informative, it's really awesome, really helpful, answers a lot of the questions you might have.’
The availability of a clinical expert to call on was also described as critical to support their work within their clinics.
“I think with Dr. [name] and Dr. [name] coming down and having that clinical expertise was helpful for them to feel more comfortable.”
Reported barriers were more varied, and focused on factors internal to the trainees’ clinical setting, the trainees themselves, the characteristics of the Six BB program itself and, to a lesser extent, limitations with the training support provided. Within the organization, the facilitator was usually the only individual working to improve opioid management and this created a sense of isolation.
“I felt accountable to you all as a training team but not necessarily to my own organization. And I didn't have any collegial connections”
Lack of organizational support for protected time needed to implement the Six BB program was another barrier, as was lack of a local clinical expert who could provide clinical advice when implementing the program.
…they wanted a one on one consult with a practicing physician in a Six Building Blocks practice that sees patients that they could talk to.
The Six BBs program’s flexible timeline was perceived as occasionally contributing to a loss of momentum in program implementation.
The Six Building Blocks program…is so flexible that they're really happy that we are able to work around their timeline and work around some of the barriers they may have, but then some of the momentum can be difficult to keep up.
In addition, the trainees reported that their own lack of prior clinical experience with chronic pain management and with facilitating the implementation of the Six BBs program created challenges. Although our team’s clinician advisors were called in to serve in this role of a clinical expert, the lack of such an expert or champion within their clinical setting was a challenge.
But then when I, who am not a provider, was talking to other clinics without my [clinician champion] or whoever, kind of my mentor, I'd get a little bit stuck.
The trainees also reported that the loss of two trainees in the program diminished the peer support and shared learning, as there were fewer experiences discussed.