Facilitation is a pivotal process in the creation, adoption and implementation of both local and national clinical guidelines, as John Davis explains

The skill of facilitation is currently highly prized within the 'new NHS', with its emphasis on delivering an ambitious agenda and implementing a plethora of guidance and guidelines – each one well intentioned but leaving clinicians staggering under the weight of the collective whole.

Facilitation is the process of assisting individuals, groups and organisations in working towards achieving their goals. The term facilitation derives from the Latin facilis, which means easy. The dictionary defines a facilitator as 'one who makes easy'.

Good facilitation can generate ownership of national guidelines and help tailor them to local situations, and encourage equity in their adoption and funding. It can also help produce local guidelines to fill the gaps where no national view pertains.

Consultation

Initially the facilitator must help the client define the issue or problem, set objectives and determine the best approach to move forward.

Planning

The facilitator may need to book a venue for the facilitation session, develop an agenda, brief participants and provide reading material and travel instructions.

Preparation

The facilitator will need to be up to date with the state of play regarding national guidelines and local implementation. He will need to have done his homework on the individuals and organisations involved, and the local politics and relevant history.

Running the session

Venue: It is best to choose a location that is convenient for the majority of participants.

Because full participation is crucial, the facilitator should make sure that the room has plenty of space and light, is a comfortable temperature, and is set up as an open U shape so that all the participants can see each other, with the facilitator at the front.

Ensure that water, paper and pens are available, and plan the sessions to optimise time.

At the start: Make sure that everyone understands the goal/objective/outcome of the session.

It is essential to set out the terms of reference and to share values and the principles of decision making, particularly if a consensus cannot be achieved.

During the session: It is critical for the facilitator to:

  • Focus on the process and let the group tackle the problem, while encouraging everyone to join in
  • Not allow individuals to dominate the proceedings
  • Keep participants on track and working to deadlines and milestones.

It is necessary for the facilitator to remain neutral and not try to lead the group to a preconceived solution of his own, as it is vital to retain the group's respect and trust.

The facilitator needs to show empathy and support to encourage individuals and the group, praising contributions and insights and giving constructive feedback.

Probably the best way of gauging progress is to observe the body language of individuals and the group as a whole:

  • Clusters of open gestures – leaning forward, direct eye contact, nodding in agreement and mirroring each others' postures – are encouraging signs.
  • Clusters of closed gestures and barriers, such as crossed arms and legs, clenched fists, little eye contact and leaning away from colleagues, are signs that not all is well.
  • Classic signs such as hands at the back of the neck and hands covering mouths may indicate frustration, and individuals looking at their watches and shuffling their papers are signals that they are running out of time.

The facilitator needs to allow the group to confront problems and issues as it is cathartic to air differences and it helps the group to move on. However, it is crucial to control conflict and ensure that the session focuses on issues and not on attacking personalities and their views.

It is best to steer the process by using open questions that draw on Kipling's 'six honest serving men that taught me all I know – their names are What and Why and When and How and Where and Who'. This will help individuals to open up and ensure motivation and commitment to the solution.

Closed questions work best when the process requires a Yes or No answer, such as 'Are we agreed on this approach?' and 'Is this decision acceptable to everyone?

If the process becomes bogged down, a summary can work well, acknowledging progress so far. Also, restating the objective gives a reference point and can refocus the group.

If the group does hit a brick wall, an experienced facilitator can draw on examples of how other groups he/she has worked with have tackled similar issues, and see what aspects of that approach could be transplanted to this set of circumstances.

At the end: The facilitator needs to sum up, restate the decisions and set out the actions, responsibilities and milestones for taking the project to the next stage or implementing it if it is completed.

Follow-up: The facilitator can produce, supervise or edit the notes, minutes and actions from the meeting and act as a catalyst by following up the organisation or individual to encourage implementation.

Most effective facilitators share certain core characteristics, e.g. open, honest, fair, empathic, and assertive, but are prepared to be flexible.

They need to get to the nub of the issues and dissect out the important from the trivial, and be positive in their outlook and solution oriented. A good sense of humour can be an invaluable asset.

It is important in selecting a facilitator that the chemistry feels right and that they have hands-on experience in delivering results and not just a superb knowledge base and a first-class intellect.

Facilitators need to be analytical and systematic in their approach. They must have good all-round communication skills.

They should be good presenters, be capable of chairing sessions, and be able to negotiate solutions and mediate to try to achieve consensus.

Experienced facilitators build up a bank of knowledge, theories and techniques, both from academic institutions and from their own experience, into which they can dip as appropriate.

Understanding behavioural science, systems thinking, group dynamics and motivation theory can provide valuable insights.

Techniques such as brainstorming, mind mapping, SWOT (strengths, weaknesses, opportunities and threats) and force-field analyses can be utilised in the appropriate circumstances to clarify issues, generate ideas and input, overcome objections and barriers, and optimise limited organisational capacity.

 

Join the Guidelines in Practice Facilitators Database

We are currently developing a database of healthcare professionals working in the NHS who are already acting as facilitators or are interested in becoming facilitators.

The aim of this database is to form a network of contacts which will enable us to pass on requests for help with local implementation to faciltators working in the area of interest.

To recieve further information and an application form for joining the database, please email facilitators@eguidelines.co.uk

 

Guidelines in Practice, October 2001, Volume 4(10)
© 2001 MGP Ltd
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