Open Access Highly Accessed Research article

Primary care quality improvement from a practice facilitator’s perspective

Clare E Liddy12*, Valeriya Blazhko12, Molly Dingwall3, Jatinderpreet Singh1 and William E Hogg12

Author Affiliations

1 C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada

2 Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada

3 Faculty of Medicine, University of Toronto, Toronto, ON, Canada

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BMC Family Practice 2014, 15:23  doi:10.1186/1471-2296-15-23

Published: 3 February 2014



Practice facilitation has proven to be effective at improving care delivery. Practice facilitators are healthcare professionals who work with and support other healthcare providers. To the best of our knowledge, very few studies have explored the perspective of facilitators. The objective of this study was to gain insight into the barriers that facilitators face during the facilitation process and to identify approaches used to overcome these barriers to help practices move towards positive change.


We conducted semi-structured interviews with four practice facilitators who worked with 84 primary care practices in Eastern Ontario, Canada over a period of five years (2007–2012). The transcripts were analyzed independently by three members of the research team using an open coding technique. A qualitative data analysis using immersion/crystallization technique was applied to interpret the interview transcripts.


Common barriers identified by the facilitators included accessibility to the practice (e.g., difficulty scheduling meetings, short meetings), organizational behaviour (team organization, team conflicts, etc.), challenges with practice engagement (e.g., lack of interest, lack of trust), resistance to change, and competing priorities. To help practices move towards positive change the facilitators had to tailor their approach, integrate themselves, be persistent with practices, and exhibit flexibility.


The consensus on redesigning and transforming primary care in North America and around the world is rapidly growing. Practice facilitation has been pivotal in materializing the transformation in the way primary care practices deliver care. This study provides an exclusive insight into facilitator approaches which will assist the design and implementation of small- and large-scale facilitation interventions.

Practice facilitation; Practice facilitators; Cardiovascular health; Primary care; Quality improvement; Practice culture