Background Our team has conducted and published multiple implementation evaluations in VA; the same core set of barriers are repeatedly identified that negatively impact implementation success. Key gaps associated with poor or failed implementation are related to the Process domain described by the Consolidated Framework for Implementation Research (CFIR): lack of planning, engaging, and reflecting on and evaluating progress of implementation. Methods used by quality improvement (QI) collaboratives are successful in helping local teams implement change. Yet, this approach tends to be resource-intensive, requiring travel and time off for multi-day sessions and site visits by expert facilitators. A structured scalable, cost-effective approach for building skills to implement change is needed among frontline clinicians and staff. Our QUERI program developed the ?Learn. Engage. Act. Process.? (LEAP) Program to address this need. Significance/Impact Dr. Stone, the Executive in Charge for VHA has made becoming a High Reliability Organization (HRO) a top priority for VHA. One of three pillars of HRO and a foundational capability necessary for learning health systems is Continuous Process Improvement, where all employees routinely work together using QI methods make improvements in clinical processes and practices. Employees must have the necessary skills and feel empowered to innovate and implement QI initiatives to ultimately impact Veterans? health and well-being. These same skills are critical for implementing evidence-based innovations. However, in baseline surveys administered to 109 employees from 20 VHA medical centers, respondents rated their QI skills below three on a six-point scale in five of six categories of QI methods. Hands-on learning of QI methods for employees within everyday clinical work is essential for achieving HRO goals and to become a learning health system. Innovation Our team developed LEAP specifically to help teams implement effective changes within busy clinical settings. LEAP is unique in providing small ?bites? of new content which teams immediately apply within their own clinical setting to achieve aims that are their highest priority. LEAP draws on curriculum developed by HarvardX and the Institute for Healthcare Improvement (IHI) and comprises four evidence-based implementation strategies: 1) create a learning collaborative, 2) assess for readiness and identify barriers and facilitators, 3) audit and provide feedback, and 4) conduct cyclical small tests of change. LEAP is cost-saving because coaching is provided using a webinar platform with support of an online collaboration platform. LEAP is fully developed and packaged for delivery to more teams.
Specific Aims We have two aims:
Aim 1) Provide LEAP training in quality improvement methods to VHA clinical teams, helping clinics achieve VHA?s HRO goal of Zero Preventable Harms to Veterans;
and Aim 2) Train additional LEAP coaches using a train-the-trainer model to expand reach to more teams. Methodology We will work with paying partners to deliver LEAP to improvement teams. Our IHI-trained coaches will lead teams through LEAP?s structured curriculum to: 1) form their team and develop an improvement aim (weeks 1-10); 2) develop a project charter that includes outcome, process, and balancing measures of success (weeks 11-14); 3) execute and test the change and monitor progress (weeks 15-26); 4) present results, including lessons learned (weeks 24-25); and 5) plan for future cycles of change. We will also identify and train new coaches to deliver LEAP to more teams. We will use pre-post assessments, interviews and document review to evaluate the training hub impact on individual, team, and health system outcomes in the following domains: satisfaction with LEAP, skill acquisition, impact on work and identified clinical outcomes.
The Veterans Health Administration (VHA) is leading a high priority cultural transformation to become a High Reliability Organization (HRO) and learning health system. A key foundation for both is that all employees, especially frontline clinicians and staff who directly provide care for Veterans, routinely engage in improving care processes and programs for Veterans. We developed the Learn. Engage. Act. Process. (LEAP) program to empower frontline employees to improve clinical programs. LEAP is effective and can be delivered at low cost to clinical teams who participate. LEAP is a structured program with hands-on learning within everyday clinical work; there is no need for travel or taking time off. LEAP coaches work with teams individually and through online group collaborative sessions. So far, 44 teams have participated in LEAP and reported significant improvements in QI skills, high satisfaction with LEAP, and most participants plan to continue making improvements in care delivery, which benefits the Veterans they serve.