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Following a natural experiment of guideline adaptation and early implementation: a mixed-methods study of facilitation

Elizabeth J Dogherty1*, Margaret B Harrison1, Cynthia Baker2 and Ian D Graham3

Author Affiliations

1 School of Nursing, Queen's University, Rm 200 - 78 Barrie St., Kingston, ON K7L 3N6 Canada

2 Canadian Association of Schools of Nursing, 99 Fifth Ave., Suite 15, Ottawa, ON K1S 5K4 Canada

3 Canadian Institutes of Health Research, 160 Elgin St., 9th Floor AL 4809A, Ottawa, ON K1A 0W9 Canada

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Implementation Science 2012, 7:9  doi:10.1186/1748-5908-7-9

Published: 6 February 2012



Facilitation is emerging as an important strategy in the uptake of evidence. However, it is not entirely clear from a practical perspective how facilitation occurs to help move research evidence into nursing practice. The Canadian Partnership Against Cancer, also known as the 'Partnership,' is a Pan-Canadian initiative supporting knowledge translation activity for improved care through guideline use. In this case-series study, five self-identified groups volunteered to use a systematic methodology to adapt existing clinical practice guidelines for Canadian use. With 'Partnership' support, local and external facilitators provided assistance for groups to begin the process by adapting the guidelines and planning for implementation.


To gain a more comprehensive understanding of the nature of facilitation, we conducted a mixed-methods study. Specifically, we examined the role and skills of individuals actively engaged in facilitation as well as the actual facilitation activities occurring within the 'Partnership.' The study was driven by and builds upon a focused literature review published in 2010 that examined facilitation as a role and process in achieving evidence-based practice in nursing. An audit tool outlining 46 discrete facilitation activities based on results of this review was used to examine the facilitation noted in the documents (emails, meeting minutes, field notes) of three nursing-related cases participating in the 'Partnership' case-series study. To further examine the concept, six facilitators were interviewed about their practical experiences. The case-audit data were analyzed through a simple content analysis and triangulated with participant responses from the focus group interview to understand what occurred as these cases undertook guideline adaptation.


The analysis of the three cases revealed that almost all of the 46 discrete, practical facilitation activities from the literature were evidenced. Additionally, case documents exposed five other facilitation-related activities, and a combination of external and local facilitation was apparent. Individuals who were involved in the case or group adapting the guideline(s) also performed facilitation activities, both formally and informally, in conjunction with or in addition to appointed external and local facilitators.


Facilitation of evidence-based practice is a multifaceted process and a team effort. Communication and relationship-building are key components. The practical aspects of facilitation explicated in this study validate what has been previously noted in the literature and expand what is known about facilitation process and activity.

facilitation; facilitator; evidence-based practice; nursing; guideline