Review identifies mechanisms supporting external facilitation of complex healthcare interventions

A realist synthesis published in Implementation Science examined how, why, and under which circumstances external facilitation supports implementation of complex healthcare interventions. Researchers, clinicians, research staff, and patient partners developed an initial theory using implementation-science frameworks. They then refined it using 36 primary studies identified through a previous scoping review, covering 34 complex interventions, alongside 105 additional sources.

The analysis identified 14 context–mechanism–outcome configurations organized into four recurring patterns: developing shared understanding and coherence; building capacity and self-efficacy; establishing and maintaining good relationships; and fostering engagement and ownership. The refined theory also highlighted team cohesion and external facilitators’ ability to turn implementation barriers into opportunities.

For clinicians and teams introducing complex services, the findings offer a framework for considering how facilitation may work in their setting, rather than a quantitative estimate of its effectiveness. The synthesis developed an explanatory theory; the next phase will test and refine it through a realist evaluation. Funding came from Canadian public and academic sources, and the authors declared no competing interests.