|Role||Excerpts from observation notes|
|Teacher||In practice 3, the facilitator gave a very structured PowerPoint presentation of the DCM. Before beginning, the facilitator said: ‘just interrupt, if anything is unclear’. He then described the system, how to sign-up, how to record and access the patient data, and how to use the system for quality improvement. The facilitator did most of the talking, sometimes answering questions from the practice. The presentation lasted for about one hour with the facilitator loosely skipping over some slides or just reading them aloud.|
|Super user||In practice 10 with only one GP present, the facilitator emphasised that the GP should be the one sitting in front of the computer. The facilitator sat next to him, guiding him. The GP had installed the DCM some time ago but had not used it. They looked at his ICPC-diagnosis coding percentage and the facilitator showed how him to use the DCM. The facilitator found that the system set-up was not correct and that the GP was not typing all values in the right boxes. The facilitator suggested that the GP contacted his system provider […]. At the next facilitation visit, the facilitator asked the GP if he had increased his coding percentage and once again found problems in the system set-up. The facilitator contacted the IT-system provider who explained how to set up the system and the GP learned this as well.|
In practice 7 the facilitator explained that as an inspiration she would now describe how she had organized the COPD treatment in her own practice. She did so in detail using a PowerPoint presentation. There were a few comments along the way, but mostly the facilitator talked, while the practice was listening. The facilitator underlined that this was her way of organizing the clinic, and that the practice should find out how they wanted to do it.|
Prior to the facilitation visit, practice 3 had chosen to focus on the DCM. Before giving a detailed introduction to the DCM the facilitator stated ‘there are three main gains from using the DCM and I am not saying it as a representative of the Region, but because I am working with it myself in my practice’. During the visit several references to the facilitator’s own practice were made, both on the initiative of the facilitator and of the practice.
|Process manager||Practice 7 and 12 had chosen to make new procedures for their COPD care. At the end of the first visit the facilitator ensured that 2–3 tasks were specified and that people in charge of each were chosen. At the second facilitation visit, the facilitator began going through the list of tasks asking about the status. In both practices, the appointed people answered that the procedures had been formulated. In practice 7 they were already using the new procedures, and the facilitator asked if they were functioning well, and they agreed that they were. In practice 12 one team member had made a draft and an internal meeting had been scheduled. In neither of the two practices was the content of the procedures discussed.|
|Coach||As mentioned above Practice 1 was the only observed practice where the facilitator attempted to engage in a more coaching based approach, although this was not fully enacted. The facilitator tried to get the participants to reflect on their own practice through an exercise where each participant wrote down the things that worked well in their diabetes care as well as ideas for improvements and potential barriers. The facilitator then asked each participant about their thoughts. Several issues were brought up during the exercise, but not as a dialogue between the practice members. Rather they stated if they agreed or disagreed with each other’s statements addressing their comments to the facilitator. Also, they did not discuss how to proceed and instead the facilitator suggested that (before the next visit) the practice should arrange an internal meeting to discuss two patient cases and their ideas about how to improve the structure of diabetes care.|