The Need for Coaches in the Clinical World

Five papers in this issue could be read with hope and despair about change in clinical care, but I believe they all call for coaches—the need for facilitation in practice transformation. These studies offer important insights about facilitating behavior change, the importance of culture, respecting complexity, and the real risk that our nation’s quality payment program is mass delusion. Starting with the most promising, EvidenceNOW is an important, largescale test of change facilitation in frontline practice (Cohen et al). The integration of an evaluation plan (ESCALATES) and intense intention to learn was certainly part of its secret sauce, producing dozens of useful studies along the way. The manuscript in this issue reports on the role of practice conditions and facilitation on improving blood pressure and smoking cessation, finding that smaller and physician-owned practices are more likely to have sufficient agency and capacity for translating motivations into change and improvement than larger or system-owned practices. The authors find practice facilitation to be an important ingredient for change, but particularly in the latter clinics. This is an important lesson given the rapid shifts in practice ownership and health system consolidation. The paper adds to evidence for federal and state investments in practice facilitation and is also testament to a decade of careful, thoughtful investment by the Agency for Healthcare Research and Quality in learning how to support practice transformation.