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QUERI – Quality Enhancement Research Initiative

Implementation Facilitation Training Manual

Using Implementation Facilitation to Improve Healthcare

Implementing evidence-based practices and programs, indeed any complex clinical innovation, is challenging. Facilitation is a strategy with proven success in supporting implementation efforts. Facilitation has been widely used in many fields (e.g., management, education, social work, community development, mediation, as well as healthcare). Typically, we think about facilitation as a process of working with groups to support participatory ways of doing things. Group facilitators are generally experts in the process of helping groups, e.g., make decisions and identify and solve problems. Although group facilitation may be used to support implementation efforts, it may not be sufficient to help complex healthcare organizations make the changes needed for improved clinical practice. The tools described on this page  focus on implementation facilitation (IF), a multi-faceted process of enabling and supporting individuals, groups and organizations in their efforts to adopt and incorporate clinical innovations into routine practices. Facilitation can incorporate or include many other implementation strategies, e.g., audit and feedback, education and training, and stakeholder engagement.

Implementation Facilitation Training Manual (Version 3)

The purpose of this manual is to 1) provide information and resources for individuals seeking to understand and apply implementation facilitation, and 2) support the development of the skills facilitators need to help organizations implement innovations. The manual incorporates implementation science and clinical operations expertise and includes practical recommendations for applying evidence-based implementation strategies that can improve uptake of evidence-based clinical practices by targeting barriers at the provider or health care organization levels. Although there are other publicly available materials that serve the same purpose, this manual also provides practical guidance for supporting implementation of innovations within Department of Veterans Affairs (VA), Veterans Health Administration facilities.

This version of the manual reflects the latest IF research and theory, as well as the experiences of IF experts. It is a practical resource for those who are new to implementation facilitation and those who have been applying it for years. It is a work in progress and will be informed by future findings from implementation facilitation studies as well as possibly your own experiences. We invite you to provide us with feedback and materials or resources that may be helpful to others who are embarking on this journey (send to We encourage you to share this manual or the link to it with others, both in and outside of VHA.

Suggested citation:

Ritchie MJ, Dollar KM, Miller CJ, Smith JL, Oliver KA, Kim B, Connolly, SL, Woodward E, Ochoa-Olmos T, Day S, Lindsay JA, Kirchner JE. Using Implementation Facilitation to Improve Healthcare (Version 3). Veterans Health Administration, Behavioral Health Quality Enhancement Research Initiative (QUERI), 2020. Available at:

Addendum 1: Key Steps in Implementation Facilitation

The purpose of this document is to convey concise, high-level information about the implementation facilitation process. It presents a list of key steps associated with most implementation facilitation efforts. It builds upon information provided in the Implementation Facilitation Training Manual v3. This list is not meant to be exhaustive nor detailed. Specific locations in the Manual with more detail on the steps are included with the step description.