1009 — Implementing Research: Lessons Learned from Improving Clinical Performance Measures

Woodbridge PA (Nebraska Western Iowa VA HCS, UNMC College of Public Health), Woodward-Hagg H (VA HSRD Center on Implementing Evidence Based Practice), Williams L (Stroke QUERI), Bravata DM (Stroke QUERI), Damush TM (Stroke QUERI), Plue L (Stroke QUERI), Butler P (Roudebush VAMC)

Objectives:
In Crossing the Quality Chasm: A New Health System for the 21st Century (2001), the IOM highlighted the enormous gap between evidence-based care and clinical practice. Recently, Dr. Clancy, Director of the AHRQ, and VA Leadership have expressed concern that there has been little progress in accelerating the rate of adoption of evidence based care (VA National HSR&D Meeting, February 2008). The VA, in its remarkable quality transformation, has used clinical performance measures to drive the adoption of evidence-based care. However, substantial variation in medical center performance persists. In the current evidence-based care development cycle, discovery is separated from implementation. Investigators discover best practices in controlled studies. Once identified, best practices are usually turned over for implementation to operations personnel. However, significant gaps exist in this process resulting in implementation delays. For example, operations staff may not appreciate significance, have competing priorities, or lack skills to effect meaningful change. One approach to closing this gap would be for investigators to enter into active partnerships with operations in the dissemination and implementation of their discoveries. In a year-long effort to improve the performance in one VA, we have developed an empiric model for implementing evidence-based care (improving clinical performance measures) grounded in systems engineering. It rests on four core principles - ownership, capability, culture, and metrics. It incorporates partnerships between research and operations. Through this model, we were successful in raising the medical center’s national ranking in clinical performance measure implementation from 103 of 139 to second in the nation. We are now expanding its application to improving the performance of another VA medical center, as well integrating it into Stroke-QUERI implementation strategies. In this workshop, participants will learn to become effective partners with operations in dissemination and implementation. Specifically, they will develop an understanding of: 1) ownership; 2) basic improvement capabilities such as goal setting, lean, rapid cycle change, PDSA, and team building; 3) supportive organizational cultures; and 4) implementation metrics.

Activities:
Didactic presentations and hands on improvement exercises to reinforce didactic teachings and to build participant confidence in effecting implementation.

Target Audience:
Translational research investigators.

Assumed Audience Familiarity with Topic:
None.