BACKGROUND/RATIONALE:
The Veterans Health Administration (VHA) needs to develop efficient ways to broadly implement evidence based practices and foster a learning organization culture that systematically and continuously applies research to improve VA healthcare. Recognizing this need, VHA Health Services Research and Development (HSR&D) invited applications in the fall of 2003 for collaboration HSR&D investigators and Integrated Service Networks (VISNs) on a) implementing and evaluating an evidenced-based interventions or b) undergoing and evaluating an organizational or structural change to transform the VISN in to a learning organization that can efficiently implement evidence-based practices. Collaborations are intended to help improve clinical services locally within participating VISNs and provide templates for expanding successful changes nationwide.
OBJECTIVE(S):
Evidence-based clinical practices (EBCPs) are often not widely adopted, despite extensive efforts to influence individual practitioners to use them. Targeting diffusion efforts only to individuals generally fails because providers do not act in isolation. They are part of health care organizations that affect their behavior and that facilitate or impede EBCPs. The aim of the project is to work with three VISNs (1, 10, 23) and their medical centers to create and test organizations that facilitate the use of EBCPs. The research objectives are to:
Test the effectiveness of the proposed organizational model in comparison with a more limited data-feedback strategy in improving system use of a selected EBCP;
Identify and analyze organizational factors that affect model implementation;
Test the feasibility of intervention activities to introduce and support the model.
METHODS:
The project is using an action-research design to implement the intervention models in and time-series, pre-post and comparison group designs to evaluate their success. The organizational model being used in arm 1 has three components: 1) active leadership commitment to quality, 2) clinical process redesign to incorporate EBCPs into routine operations, and 3) structures and processes to provide management support. Clinical process redesign focuses on increased compliance with CDC hand-hygiene guidelines. The model was introduced in two waves in VISN 23. Pre-model performance of wave 2 facilities will serve as the comparison group for wave 1 early implementation performance. In arm 2, a data feedback strategy will be implemented in VISNs 1 and 10 to provide both a test of effectiveness of a more limited diffusion strategy and another comparison group for the organizational model study arm.
Two measures are being used to test the interventions' effectiveness in improving system compliance with hand-hygiene practices: 1) use of hand-hygiene supplies and 2) direct observation of conformance with hand-hygiene guidelines. Data will be analyzed at facility level and at the unit level nested within medical center and VISN. Intervention activities used to introduce and support the model are being documented to confirm their consistency across sites. Extent of model implementation and factors that affect implementation will be identified through interviews and surveys. Extent of implementation is being be quantified in an implementation index. Factors that affect implementation will serve as independent variables in multiple regression analyses to predict levels of implementation of the organizational model.
FINDINGS/RESULTS:
None available at this time.
IMPACT:
A major objective of the solicitation to which the proposal is responding is to generate knowledge that will facilitate the implementation of EBCPs nationally. Regardless of whether the hypotheses are supported, the study will contribute to the theoretical knowledge and understanding of the factors that affect the successful adoption of EBCPs. If our hypotheses are supported, the study will offer practical strategies for creating organizations that facilitate EBCPs.
PUBLICATIONS:
Journal Articles
- Lukas CV, Holmes SK, Cohen AB, Restuccia J, Cramer IE, Shwartz M, Charns MP. Transformational change in health care systems: an organizational model. Health Care Management Review. 2007; 32(4): 309-20.
- Singer S, Meterko M, Baker L, Gaba D, Falwell A, Rosen AK. Workforce perceptions of hospital safety culture: development and validation of the patient safety climate in healthcare organizations survey. Health Services Research. 2007; 42(5): 1999-2021.
