Diffusion of Excellence Accelerating the Implementation of Best - - PowerPoint PPT Presentation
1 Diffusion of Excellence Accelerating the Implementation of Best Practices in Americas Largest Integrated Healthcare Delivery System Shereef Elnahal, MD, MBA Assistant Deputy Under Secretary for Health for Quality, Safety, and Value
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Accelerating the Implementation of Best Practices in America’s Largest Integrated Healthcare Delivery System
Shereef Elnahal, MD, MBA Assistant Deputy Under Secretary for Health for Quality, Safety, and Value Department of Veterans Affairs
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#VADiffusion
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#VADiffusion
within primary care clinics (70%) and eye clinics (30%)
records (CPRS), Imaging archive (VistA Display), imaging tools (TeleReader)
implementation team and imaging support
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#VADiffusion
268 patients examined by TRI and retina specialist
Cavallerano AA, et al. Retina 2003; 23: 215 – 223.
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#VADiffusion
From: Effect of a Teleretinal Screening Program on Eye Care Use and Resources
JAMA Ophthalmol. 2014;132(9):1045-1051. doi:10.1001/jamaophthalmol.2014.1051
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#VADiffusion
Teleretinal Encounters from FY06- FY2014 = 1,544,274*
* FY06 – FY14 *Extrapolated to Q4 2014 = 1,165,274* to Q4 2014
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10 20 30 40 50 60 70 80 90 100 FY00 FY02 FY04 FY06-3rdQt FY08-3rdQt FY10-3rdQt FY12-3rdQt FY14-3rdQt FY16-3rdQt VA Performance Goal
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#VADiffusion
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Background
The Veterans Health Administration (VHA) is America’s largest integrated health care delivery system, with over:
While VHA is a leader in the delivery of high quality health care, it has lacked consistency in the application of best practices We sought to develop a method to effectively identify, diffuse, and sustain best practices in this heterogeneous system
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Diffusion of Excellence Objectives
Identify and scale innovations across VHA, while: Empowering employees to promote innovation sharing and drive a supportive culture of continuous improvement Institutionalizing processes and mechanisms for systematically diffusing and implementing promising practices throughout the system Minimizing negative variation, and standardizing practices by diffusing innovative and industry recognized best practices across the system
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How long does it take for randomized evidence to change clinical practice widely?
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Enabling success by leveraging three organizing principles
Process
evaluation, adaptation, and reapplication of practices
Governance
agency priorities
leadership and staff
Technology
regions and boundaries
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Find the Champions
Local champions, or ‘early adopters,’ serve as sharks in a ‘shark tank’ style event. Those selected as implementers identify local champions to lead.
Replicate
Establish Consistency & Standardize
Leverage national program office leader support to select those ready for national rollout and support standard development and scaling.
Sustain and Improve
Establish a robust operations center for managing and tracking
implementation.
Identify Promising Practices
Solicit practices nationally and engage staff at all levels, including projects from the VA Innovators Network and Communities of Practice, to evaluate them using a rigorous set of criteria.
Adapt and Replicate
Leverage Diffusion Council governance structure to engage field staff and leaders during initial replication to support issue resolution; Use advanced technology tools and project management resources to track and monitor progress.
Model for Disseminating Best Practices
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Identify Promising Practices 13
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Find the Champions
14 Gold Status Practices 435 Practices Submitted
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Adapt and Replicate
Diffusion of FY17 Gold Status Practices Across VHA
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Establish Consistency and Standardize
Driving success through process
Facilitated adaptation and implementation Use of human centered design and LEAN frameworks Peer-to-peer learning between designers and adapters Project management and technical support Processes in place to provide resourcing when needed
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Sustain and Improve
Accelerating and sustaining adoption and uptake with technology tools
Pulse platform promotes conversation and sharing about promising practices Virtual VA “Shark Tank” style event enabled virtual engagement in unique opportunity to ‘pitch’ promising practices Diffusion Hub provides robust project management and tracking tools to manage replication and implementation of best practices, all based on LEAN principles and frameworks
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Results
Launched in October 2015, VHA is implementing 390 adaptations of Gold Status practices at 100 facilities
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planning, in progress, and in completion
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Results
National Deployment - Planning Update
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Access Data Dashboard to Improve Clinic Management Increasing Access to Primary Care with Pharmacists Improving Same-Day Access Using RNCM Chair Visits eScreening Regional Liver Cancer Tumor Board Unit Tracking Board WAKE Score for Recovery from Anesthesia Flu Self-Reporting Desktop Icon Planning for Future Medical Decisions via Group Visits
Access Care Coordination Employee Engagement Quality and Safety National deployment planned; no roadblocks National deployment planned but facing roadblocks National deployment determination requires additional analysis
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Implementation Measures and Outcomes
Sub-Initiative Title Description Stage Sub-Initiative Metric Facilitate Bi-Annual Under Secretary for Health Shark Tanks
Facilitate two Under Secretary for Health Shark Tanks in FY17 to share, vet, and pledge to adopt best practices Implement # of Shark Tanks Held
Launch Diffusion Program
Ensure VISNs and VAMCs elevate promising practices and implement best practices in their
Implement # of VISNs and VAMCs which have Adopted and Shared Best Practices
Implement FY17 Gold Status Best Practices
Facilitate the implementation of the identified best practices from the FY17 Shark Tanks with the partner VAMCs Plan # of Gold Status Best Practices Successfully Implemented
Achieve National Scale in Select FY16 USH Gold Status Best Practices
Achieve national scale (implementation projects in every medical center) in at least 3 out of the 8 FY16 USH Gold Status Best Practices with scale potential Implement # of FY16 Gold Status Practices Implemented VHA- wide
Initiative Title Outcome Statement Initiative Metric Diffusion of Excellence
Institutionalize a culture within VA medical centers that encourages sharing & adoption of best practices throughout the system to drive towards a high reliability organization Total # of Best Practice Replications (ongoing or completed)
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Findings
VA Innovation Engine – empowering and enabling those who know VA best to make it better
engagement through different pathways of innovation
best practices into Diffusion of Excellence
and dissemination of excellence
peer-to-peer sharing
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Implications for Dissemination and Implementation Research
solution that can scale best practices across VA’s healthcare system
is using Implementation research in their evaluation of Diffusion of Excellence
analysis)
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Rate of VA Diffusion under Diffusion of Excellence: 1-2 Years for National Standardization
(Best Practice: Veteran direct scheduling into audiology and optometry)
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Proving the Rogers Model
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Questions/Comments
Please contact Dr. Shereef Elnahal (Shereef.Elnahal@va.gov) with any questions or concerns