(1271) Facilitation Role in Transforming Community Pharmacy Practice: Lessons Learned

Objectives: The objective of this research was to use a facilitation model to examine the association between facilitators in the Flip the Pharmacy initiative and community pharmacy practice transformation. The Community Pharmacy Foundation (CPF) partnered with Community Pharmacy Enhanced Services Network (CPESN) USA and started Flip the Pharmacy (FtP) program in 2019. The goal of FtP is to transform community pharmacy practices and business models to be patient-centered and professionally sustainable. Flip the Pharmacy utilizes hands-on peer coaching and evidence-based change packages to support community pharmacy practice transformation. The practice facilitation model promoted by AHRQ identifies coaching and the use of facilitation tools (e.g. change packages and eCare plans vendor materials) as key components of facilitation. Limited information is known about how FtP program facilitation strategies relate to actual practice transformation. Learning more about the link between facilitation and practice transformation could help refine strategies for community pharmacy practice transformation such as FtP.

Methods: A cross-sectional survey, containing both close-ended and open-ended questions, was conducted of pharmacies participating in cohorts 1 and 2 of the FtP program at the national level (n=809). A mixed mode survey administration of web and mail was used. The survey measured practice transformation, using a 5-point scale, with items based on the five components of work system in the Systems Engineering initiative for Patient safety (SEIPS) framework (v.1): people, organization, tools and technologies, tasks and environment. Facilitator’s strategies & activities and facilitation tools were included in the survey. Overall practice transformation was assessed using a scale from 0 to 10, “0 = no transformation at all” and “10 = full transformation”. Demographics and pharmacy characteristics were collected. The last section of the survey was for respondent comments about FtP and practice transformation.
To report the successful facilitation strategies, quantitative results were integrated with those of the qualitative data. Quantitative analyses were conducted through linear regressions: 1) perceived overall practice transformation as the dependent variable and facilitation strategy, facilitation tools and staffing as independent variables and 2) five regressions – one for each SEIPS component as the dependent variable and the corresponding facilitation activity and facilitation tools as independent variables. The qualitative results were coded and used to inform interpretation of the regression models.

Results: A total of 200 usable surveys were received, with 81 open-ended comments. The regression results showed that coaching facilitation strategy and facilitation tools are significant predictors for overall transformation (P-value < 0.01, β=0.365, β=0.37 respectively). Additionally, all facilitation activities and tools were significant predictors for practice transformation in their corresponding work system component.
The integration of the results showed three main factors contribute to successful program facilitation: 1) Facilitation strategy lies on a continuum: Coaching strategies varied from doing things for the pharmacy team to coaching the team and allowing them to figure out their unique solutions. A good facilitator can use different strategies depending on the situation and audience. 2) Facilitation activities should be clearly defined: Having well defined activities helped both facilitators and pharmacists. Having clear activities reduces ambiguity about the facilitator’s role, in addition to increasing the consistency of the facilitator’s performance, which can support the pharmacy team. 3) Facilitation tools support consistent facilitation: Well-designed tools can be used as a reference to guide practice transformation during primary implementation as well as when sustaining the transformation.

Conclusions: This study shows that peer coaching and facilitation tools used in the Flip the Pharmacy program positively influenced pharmacists to transform their practices. Using the SEIPS model provides a holistic approach to evaluate pharmacy practice transformation.