Objectives: To understand why some family practices with a facilitator improved preventive performance more than others. Sustainability of practice improvements one year after the intervention was also explored.
Methods: Interviews with physicians and nurses from seven practices and data gathered during the intervention were used to form case studies of three high performing and four low performing family practices. Case studies were developed using cross-case analysis with a combination of the constant-comparative method and memoing-diagramming. Two researchers independently conducted in-depth coding of transcripts and documents, individual case construction for each study site, and then cross-case analysis of the identified themes between study sites.
Results: Staff involvement and a positive attitude toward implementation of changes were central to high improvement in performance. A lack of computers, low staff involvement or high staff turnover were associated with low improvement in performance. Personal characteristics of the facilitator are important. Six of the seven practices still had the prevention tools in place one year after the intervention and all noted that participation had improved their understanding of preventive medicine.
Conclusions: When using facilitators, one should avoid practices in turmoil, strive for continuity over time, and recognise the importance of the relationship between the facilitator and the practice.