Perspectives on internal vs. external facilitation for implementing guidelines for recovery-oriented practice: a qualitative study

Abstract

Abstract Background Seven organizations supporting adults with mental health challenges collaborated with researchers to implement Chapter Six of Canada’s Guidelines for Recovery-Oriented Practice. An implementation strategy was developed that combined external facilitation, mixed Implementation Teams, a 12-meeting planning process, and ongoing coaching. This paper focuses on the facilitation component, specifically exploring participants’ perspectives on internal versus external facilitation within Implementation Teams. Methods Forty semi-structured individual online interviews were conducted with 32 members of Implementation Teams, including service users, providers, family members, managers, and knowledge users, along with eight researchers who acted as external facilitators. Participants discussed their experiences of implementing the guidelines supported by an external facilitator and were asked to consider how their experience may differ if it had been led by an internal facilitator. Results Thematic analysis identified seven themes relating to what was perceived as important about internal versus external facilitation: (1) Effect of facilitator position (external versus internal); (2) Flattening power hierarchies; (3) Enacting cultural shifts; (4) Understanding context; (5) Encouraging candour; (6) Building relationships, and (7) Internal facilitator identity and influence. These highlight how participants valued different skills, knowledge, and attributes in each scenario, with responses varying depending on the participant’s identity. No clear preference emerged for either approach. Instead, participants debated the benefits and drawbacks of both, where insider knowledge vied with outsider neutrality for primacy. Conclusions Whether facilitation is internal or external, its effectiveness relies on the facilitator’s ability to establish rapport, develop allies, and foster unity between Implementation Team members and the implementation setting itself. A blended approach, which integrates the strengths of both internal and external facilitators, may offer the most effective model for supporting the implementation of recovery-oriented practice. Author(s) Myra Piat1, Lucy Melville-Richards2, Megan Wainwright3, Eleni Sofouli1, Hélène Albert4, Marie-Pier Rivest4, Ian D. Graham5.