Tip Sheet: How a Practice Facilitator Can Support Your Practice

What Is Quality Improvement?

Quality improvement (QI) is the process by which a primary care practice continually assesses performance, plans changes in areas where improvements are warranted, monitors the effects of those changes, and refines as needed. A practice’s QI efforts are an important component of efforts to improve the quality of the health care system in the United States.

Why Take on QI?

QI efforts can help physicians get back to practicing medicine like they had originally intended—to rediscover the joy in it.

Robert Gabbay, M.D, Ph.D., Harvard Medical School

Many payers, providers, delivery systems, and other organizations are supporting QI initiatives to improve the performance of primary care practice. These shifts in the primary care landscape may heighten expectations for primary care practices to pursue QI. Many practices already engage in QI to prepare for these new expectations or to tackle specific goals identified by the practice as good for them and their patients. For example, you may want to improve overall health outcomes for your patients or job satisfaction for staff members.

Where Can You Get Help with QI?

Like many primary care practices, your practice may face many challenges to getting started with QI. You may face competing priorities. You may be strapped for time, or you may be operating on thin profit margins. Engaging in QI activities may be new for your practice, so you may not know how to begin.

External support organizations can help your practice navigate these challenges to build QI capacity. Practice facilitation, also known as practice coaching, is one type of support these external organizations can provide that can be helpful to practices in new and ongoing QI efforts. Groups that provide practice facilitation services include QI organizations; regional extension centers; professional societies; payers; and other health care organizations that own or contract with practices, such as accountable care organizations, integrated delivery systems, and medical groups. Individuals from these groups who deliver support for primary care practice have various titles. We refer to them here as practice facilitators.1

How Will a Practice Facilitator Help?

  • If you get patients involved in QI, it is hard not to fix things—and many of the fixes are easy.

    Jonathan Sugarman, M.D., M.P.H., President and CEO, Qualis Health

    A practice facilitator can start by using assessment tools to help you determine your practice’s readiness for change. The facilitator can help you identify current needs, or “pain points,” and develop your practice’s capacity for improvement to address these needs.
  • A facilitator can tailor QI efforts to your practice and help implement them.
  • A facilitator can show you how to track changes and provide feedback to your practice on its performance over time.
  • A facilitator can provide you with information on your practice’s performance compared with external benchmarks (such as regional or national averages).
  • A facilitator can introduce you to local organizations such as physician societies, groups of practices, or community agencies that share your concerns.
  • Once your QI initiative is more established, your practice facilitator can help you harness the power of patient engagement. This will allow your practice to see how your current system works through your patients’ eyes, which can help you implement changes that will improve your patients’ experience.

What Should You Look for in a Practice Facilitator?

  • Practice facilitators should be able to speak your language and be well equipped to understand your challenges. Facilitators often have clinical backgrounds in primary care.
  • You can expect facilitators to treat the task of QI as a collaborative effort with you and your staff to identify your most important QI goals and work toward them together. This approach is similar to the shared decisionmaking approach that you may be using with your patients. 

How Can You Work Best With Your Practice Facilitator to Achieve Your Goals?

As your facilitator works with you on QI, he or she will absolutely need your involvement and help. Here are a few ways you can provide it:

  • Review your practice’s values and goals with your facilitator to help you determine QI efforts that will help you meet those targets.
  • Try to choose as the first QI project one that is relatively easy to pursue and that will produce benefits quickly. Plan to build QI capacity incrementally to succeed over the long term.
  • Encourage practice colleagues — including clinicians and clinical and nonclinical staff — to participate in learning about the QI initiative and how to implement it.

Engaging in QI activities allows your primary care practice to work toward improved quality; better health; improved patient, provider, and staff experiences; and reduced cost of care. The systemic and cultural changes required for creating and maintaining QI initiatives can be difficult, but practice facilitators can guide your practice through them.

This tip sheet is based on the Agency for Healthcare Research and Quality White Paper, Engaging Primary Care Practices in Quality Improvement: Strategies for Practice Facilitators, available on AHRQ’s PCMH Resource Center Web site at

AHRQ 15-0015-2-EF
March 2015


  1. We use the phrases “QI initiatives,” “QI activities,” and “QI efforts” here to refer broadly to both specific QI initiatives and broader efforts undertaken toward practice redesign and transformation. We use the word “practice” as an umbrella term. Your “practice” may include one or many primary care practices. Go back