Table 1.

Enacting practical principles: actions, descriptions, and examples

Actions	Descriptions and examples
Assign facilitation roles	There may be several different facilitator roles (e.g., greeter, agenda facilitator, technical support) within a single virtual interaction. Be sure the external facilitators are clear on who is covering which facilitation roles. Example: The greeter should welcome participants and avoid awkward silences while participants are gathering (e.g., “Good morning, this is Ryann from the CONCERT team. The program will start in just a few minutes. In the meantime, please type your name and location in the chat box.”). Once the program starts, the greeter hands off to a second team member who facilitates the content of the meeting. While the content facilitator directs the program, another team member troubleshoots individual technical issues and/or manages chat boxes.
Create small cohorts	If there are a large number of participants, deliberately separate participants into smaller groups (organized by facility, location, role, any other relevant characteristic) to enable engagement, sharing, and encourage more meaningful interactions. It may be important to construct smaller groups that avoid hierarchical dilemmas (e.g., separating senior leaders from frontline staff for potentially volatile or personal conversations or mixing sites so supervisors are not in the same group as their own supervisees). Example: During the completely virtual external facilitation collaborative the 31 participating CLCs (> 120 individual participants) were separated into 3 cohorts for the duration of the collaborative. During a multi-day learning session cohort 1 (n = 10 CLCs, ~ 40 individual participants) was further divided into 3 smaller breakout groups. During the learning session, the 3 small groups each participated in separate online breakout sessions to discuss performance improvement projects they had implement in their individual CLCs. External facilitators present at each breakout session facilitated discussion across participants, enabling them to highlight their keys to success and other lessons learned. This facilitated discussion was used to help build PowerPoint storyboards for each small group to present during the next segment of the learning session. All small group assignments and connection information for the breakout session were included in the agenda, which was sent to all participants prior to the start of the learning session.
Provide clarity and structure for interactions with/among participants	Explicitly outline for the participants who will be serving in the various facilitation roles. Example: The attendance monitor and facilitator contacts no-shows if attendance is mandatory and keeps a database for monitoring the facilitation’s reach. The recording manager starts and stops the recording if the interaction will be recorded. The chat box moderator monitors the chat box or other communication mechanism and informs the facilitator(s) if there are issues or questions that need to be addressed. The presentation moderator shares screens and advances slides. The technical trouble shooter helps team members and participants with technical connection or other issues.
Structure content	Providing structure for the program’s content ensures participants all have similar experiences and focus on the program’s content. Example: Create a structured action plan that reinforces learning objectives for participants by guiding them through the plan in a stepwise fashion offline. We provide an example of a templated action plan as an online supplement.
Use visuals	Adding visual components to an audio presentation will enhance participant engagement and keep their attention. Be succinct and use graphics to help convey your message. Example: Construct PowerPoint slides with less text and more content-related graphics. If presenting a PowerPoint or other slides, write the important points in the notes section and keep your audience’s attention by having few words on the slides. Before breakout sessions, share a summary slide to remind participants about key issues and guide small group discussion. These bulleted talking points (e.g., please discuss the following: (1) your lessons learned, (2) what you will do differently now that you have learned this new information, (3) how you will take this forward) help participants share their experiences and learn from others.
Build in onsite activities separate from virtual experience	Create time in the agenda for participants to immediately apply learned knowledge in their local setting. Give participants a relatively simple task and reconvene the virtual group to discuss how it went and how to move forward. Example: Following a virtual presentation about how to implement a new quality improvement activity, participants from each team are given an hour to practice the activity together locally. Participants then return to the online platform to discuss how the activity went and create action plans for implementing the activity more broadly in their local site.
Create backup plans	Have a plan in place in case there are issues with technology and be sure to have a way to communicate with your team outside of the online platform. Example: The external facilitation team connects to the online platform to practice delivering the evidence-based implementation content, with assigned team roles in place. Technical difficulties are identified, so the team decides to create a text message group to use the day of the event. This enables the team members to reach each other about technical difficulties or suggestions in real time during the virtual presentation.
Engage everyone	Facilitators should invite each participant into conversations (via audio or chat), being mindful of group dynamics and continually focusing on collaborative subjects. Example: Conduct round robin check-ins during audio sessions in which all participants take turns sharing their experiences. Round robin sharing sessions can then transition to facilitated discussions in which participants and facilitators help each other brainstorm challenges and next steps.