Health care systems are complex; sustaining improvements in healthcare quality requires the use of tailored implementation strategies. However, the utilization of implementation strategies without an understanding of different organizational and leadership contexts results in healthcare improvements that are variably successful due to partial implementation or limited sustainability. Diffusion of clinical best practices requires effective leaders at every level of the healthcare system, including front-line providers and operational staff. Clinicians and staff who are ?active and influential citizens of the healthcare community? are able to influence healthcare change. Moreover, health professionals trained in leadership principles and facile with improvement strategies are better equipped to translate clinical best practices within a local healthcare context, effectively manage interpersonal relationships, and cultivate partnerships needed to spread and sustain improvement. Despite the necessity of and synergy for teaching implementation strategies and leadership concepts together, these methods are usually taught in isolation. We propose an innovative training program for a multifaceted implementation strategy that integrates the strength of an evidence-based improvement strategy, (Model for Improvement) and leadership skills for change management (Leading Change). The VA Quality Scholars (VAQS) program, a national training program at 11 VA medical centers throughout the United States, trains interprofessional clinician leaders, including physicians, nurses, clinical psychologists, pharmacists and other healthcare professionals, in quality improvement, implementation, and leadership for change management. To this end, the leaders of the VAQS Coordinating Center have developed a methodology called ?Leading Healthcare Improvement (LHI)? that integrates two empirically supported implementation strategies, evidence-based quality improvement and leadership for change management. The LHI training program has been tested with VAQS fellows and is ready to be adapted and condensed for frontline clinicians and operational staff to facilitate implementation of clinical best practices. Building upon the QUERI-funded startup period, we will continue to foster relationships with QUERI leadership and the Diffusion of Excellence program to train frontline providers, specifically Gold Status Fellows and Implementing Facility Fellows. We will finalize the adaptation of LHI program materials for frontline providers and operational staff by incorporating feedback from end-user assessments. Through the proposed program, ?Leading Healthcare Improvement: Leadership Training for Applying Improvement Strategies,? we will adapt and condense the practical knowledge and skills-based components of the VAQS LHI curricula to train frontline providers to implement clinical best practices. We will achieve the program goal of training frontline providers to effectively lead the implementation of clinical best practices through the following specific aims:
Aim 1 : Finalize the adaptation of the VAQS Leading Healthcare Improvement program to an interactive, web- based training program with supporting materials for frontline clinical providers and operational staff.
Aim 2 : Train dyadic pairs of Gold Status Fellows and Implementing Facility Fellows, and their associated teams, to conduct clinical best practice projects using the integrated LHI implementation strategy.
Aim 3 : Assess the quality and effectiveness of the Leading Healthcare Improvement program through participant and system level indicators. Fidelity of the projects to the LHI implementation strategy will be ensured through use of the LHI template as well as a fidelity rubric. Additional evaluation metrics include: trainee satisfaction with program, trainee utilization of tools, the number of providers who employ the training to scale or spread a clinical best practice, the number of Veterans impacted by the scale or spread of the clinical best practice, and the operational impact of the healthcare change resulting from the implementation and spread of a clinical best practice.
Health care systems are complex. Sustaining improvements in healthcare quality requires the use of tailored implementation strategies. However, the utilization of implementation strategies without an understanding of how to lead healthcare change results in healthcare improvements that are variably successful. Diffusion of clinical best practices requires effective leaders at every level of the healthcare system, including front-line providers and operational staff. Thus, we propose an innovative training program for frontline providers and operational staff in a multifaceted implementation strategy that integrates evidence-based quality improvement and leadership skills for change management. The proposed program, ?Leading Healthcare Improvement: Leadership Training for Applying Improvement Strategies,? will train teams of frontline providers and operational staff to implement clinical best practices through a 12-month program that includes interactive, web-based training, practical hands-on tools and materials, and facilitated, peer-mentoring and coaching.
