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QUERI Implementation Guide

Section III Part 1: Resources for Implementing Research into Practice

Selected Organizational Units of the Department of Veterans Affairs Relevant to Implementation Research

* Please note that section(s) marked by an asterisk are accessible via INTRANET ONLY.

The Department of Veterans Affairs, and the Veterans Health Administration, are large, complex organizations. Understanding some of the key offices and important functions of the agency may help implementation researchers determine who they should consult about projects they are considering, and where to go for information about the system of care. Implementation research has unique characteristics in that the context of care is critical to the success of an implementation effort. The information presented here provides an overview, and possible guideposts for further exploration and contact as you consider initiating an implementation project.

The Department of Veterans Affairs is a cabinet-level federal agency. The Secretary of the Department of Veterans Affairs is a Presidential appointee, serving at the will of the President of the United States, and confirmed by the Senate of the United States.

The *Veterans Health Administration (VHA) is a major component of the Department of Veterans Affairs. The top official in the VHA is the Under Secretary for Health. The Under Secretary for Health is appointed by the President of the United States and confirmed by the Senate, reporting to the Secretary of the Department of Veterans Affairs.

The Office of the *Under Secretary for Health is organized into several departments; you can view the organizational chart by clicking the preceding link. Biographies of current senior leaders within VHA, who serve under the Under Secretary for Health, can be viewed and following the links for each person in the organizational structure can be viewed via INTRANET ONLY .

Several key offices in the VHA are of particular importance to understanding the organizational landscape of VHA and planning for implementation research. Even at the stage of single-site or small-scale evaluations or demonstrations of innovative practices or implementation efforts, it is worth attempting connections with senior leaders within VHA, either at Central Office in Washington, DC, or in VISN (Veterans Integrated Service Networks) offices across the country.

Key organizational units within Central Office (CO) include:

• *The Deputy Under Secretary for Health




The Deputy Under Secretary for Health reports to the Under Secretary for Health, and has a broad span of organizational units reporting to him. These include:

• *The Office of Patient Care Services

  The Office of Patient Care Services is organized into Program Offices and Strategic Health Groups. These include, among others, the *Spinal Cord Injury and Disorders Strategic Health Group; the *Acute Care Strategic Health Group, which includes the Program Offices for *Cardiology,*Diabetes, and *Oncology, among others; the *Public Health Strategic Health Group, which includes the Human Immunodeficiency Virus Program; and the *Mental Health Strategic Health Group, which includes *Substance Use Disorders, as well as other groups specific to providing mental health services and research within VHA.

• The Office of Research and Development

  The Office of Research and Development (ORD) includes Health Services Research and Development (HSR&D). The National QUERI program, a program within HSR&D, consists of eight disease-specific groups: chronic heart failure, colorectal cancer, diabetes mellitus, HIV/AIDS, ischemic heart disease, mental health, spinal cord injury, and substance use disorders. Each of these is organized with a Research Coordinator, a Clinical Coordinator, an Implementation Research Coordinator, an Administrative Coordinator, and an Executive Committee. Links to each group’s web page can be found on the national QUERI page.

• *The Office of Information

  The Office of Information (OI) is responsible for maintaining, extending, and creating the data systems with which VHA operates. It is a complex organizational unit, including field-based personnel at each facility who are responsible for the operation of the clinical information system in each facility, as well as personnel at the VISN level who are responsible for VISN level information systems (including electronic mail and data security functions), and at the national level, responsible for a wide variety of functions. These include administration and oversight of the Austin Automation Center, which houses all the VHA and VA national databases; Systems Design and Development, which creates new functionality for Vista/CPRS; and many other systems which we rely on to do our daily work.

• *The Office of Quality and Performance

  The *Office of Quality and Performance (OQP) is another very complex organizational unit within VHA that is responsible for several key functions related to quality and monitoring performance. *Accreditation activities are coordinated at the national level through OQP. Performance monitoring is coordinated through the *Performance Measurement Group. Guideline development and updating and coordination of national clinical reminders are coordinated through the *National Clinical Practice Guideline Council, which is under the management of OQP. *Clinical Practice Guidelinesadopted by VA and the Department of Defense (DoD) are maintained and updated through OQP. The *External Peer Review Program is coordinated through OQP.

In addition, numerous data gathering and reporting functions are coordinated through the Office of Quality and Performance, including the *Survey of Health Experiences of Patients and other surveys through the Performance Assessment Center of Excellence (PACE). Data are presented for action through the *Executive Briefing Book. *Several successful projects implementing evidence-based practices have been collated and reported through the OQP web site.

• *The Office of the Deputy Under Secretary of Health for Operations and Management

  The Deputy Under Secretary of Health for Operations and Management reports to the Under Secretary for Health, and has a broad array of organizational units within VHA reporting to her. These include, notably:

Reporting through the Office of the Deputy Under Secretary for Operations and Management, the *National Leadership Board (NLB) is composed of the Directors of each of the 21 Veterans Integrated Service Networks (*VISNs), which constitute the operations branch of VHA in the field.

VHA is a complex organization. We recommend discussing any contacts with individuals in a VISN office or at Central Office with knowledgeable leaders within your institution before beginning dialogue about an innovation or plan for implementation of evidence-based best practices. We also recommend discussion with leadership within the national QUERI program office prior to initiating contact.

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