Diffusion of Excellence Initiative Overview Better Health...
Transcript of Diffusion of Excellence Initiative Overview Better Health...
Diffusion of Excellence Initiative Overview
Better Health PartnershipFall Learning Collaborative Summit
September 30, 2016
Shereef Elnahal, MD, MBA
Office of the Under Secretary for Health
Veterans Health Administration
Conflicts of Interest
• None
Table of Contents
• Diffusion of Excellence Overview
• Process: How we Identify and Spread Best Practices
• Leveraging the Model to Provide Top-Notch Cancer Care to Veterans
• Discussion
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Diffusion of Excellence Overview
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Background
The Veterans Health Administration (VHA) is the largest
integrated health care delivery system in the United States,
with over:
• 1,700 sites of care
• 300,000 employees
• 8.76 million Veterans served each year
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While VHA is a leader in the delivery of high quality health care, it has lacked
consistency in the application of best practices
We sought to develop a method to effectively identify, diffuse, and sustain
best practices in this heterogeneous system
Objective
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Identify
and scale
innovations
across VHA,
while:
Empowering employees
to promote innovation sharing and drive a supportive culture of continuous improvement
Institutionalizing processes and mechanisms
for systematically diffusing and implementing promising practices throughout the system
Minimizing negative variation, and standardizing
practices by diffusing innovative and industry recognized best practices across the system
Everett Rogers: Rural Sociology
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1. Innovation
2. Adopters
3. Communication Channels
4. Time
5. Social Systems
Model for Disseminating Best Practices
Find the ChampionsLocal champions, or ‘early
adopters,’ served as sharks in a
‘shark tank’ style event. Those
selected as implementers
identified local champions to lead.
Replicate
Establish Consistency
& StandardizeLeverage national program office
leader support to select those ready
for national rollout and support
standard development and scaling.
Sustain and improveEstablish a robust operations
center for managing and tracking
outcomes, in parallel with
implementation.
Identify Promising PracticesSolicited practices nationally and engaged
staff at all levels, including projects from the
VA Innovators Network and Communities of
Practice, to evaluate them using a rigorous
set of criteria.
Adapt and ReplicateLeverage Diffusion Council governance structure to
engage field staff and leaders during initial replication
to support issue resolution; Use advanced technology
tools and project management resources to track and
monitor progress.
Process
Governance
Technology
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Enabling success by leveraging three organizing
principles
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Process
• Consistent framework
for evaluation, adaptation, and reapplication of practices
Governance
• Vertical accountability
to agency priorities
• Engagement of senior leadership and staff
Technology
• Rapid and transparent flow of information
across regions and boundaries
Replication & Diffusion
Multi-level governance structure provides leadership support,
drives accountability and enables diffusion to occur at multiple levels
Identification
• Diffusion Council oversees semi-annual national Shark Tank
• Regional leaders (medical center directors) invest in those they want to implement
• Communities of practices elicit best practices
• Regional leaders host their own events to identify practices for local dissemination, and national consideration
• Mentorship from prior year cohort of best practice fellows
• Governance Board of senior executives provide resourcing and immediate issue resolution as needed
• Project management support provided to facility innovators and implementers
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Diffusion of Excellence Org Structure
• Responsible for allocating resources
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Continuous operational support
Each team is responsible for implementing 2-4 Promising
Practices
Responsible for achieving objectives
Responsible for allocating resources
Governance Board
10 Members, w/ USH as Chair
Diffusion Council
Co Chairs: Shereef Elnahal, Patrick Littlefield
Access
Action Team
-Team Lead
-Gold Status Fellows
-Implementing Facility Fellows +
Stakeholders
Employee
Engagement
Action Team
-Team Lead
-Gold Status Fellows
-Implementing Facility Fellows +
Stakeholders
Care Coordination
Action Team
-Team Lead
-Gold Status Fellows
-Implementing Facility Fellows +
Stakeholders
Quality & Safety
Action Team
-Team Lead
-Gold Status Fellows
-Implementing Facility Fellows +
Stakeholders
Executive Sponsor: David Shulkin, Under Secretary for Health
Driver: Shereef Elnahal
Support: Veterans Engineering Resource Center (VERC), VA Center for Innovation (VACI)
Contractor Support: ERPi/Atlas Research
Diffusion Framework: How we
Identify and Spread Best Practices
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Driving success through process
Facilitated adaptation and implementation
Use of human centered design and LEAN frameworks
Peer-to-peer learning between designers and adapters
Project management and technical support
Processes in place to provide resourcing when needed
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Process
Accelerating and sustaining adoption and uptake
with technology tools
Pulse platform promotes conversation and sharing
about promising practices
Virtual VA “Shark Tank” style event enabled virtual
engagement in unique opportunity to ‘pitch’ promising practices
Diffusion Hub provides robust project
management and tracking tools to manage replication and implementation of best practices, all based on LEAN principles and frameworks
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Integrated Operations Platform:
VA Diffusion of Excellence Hub
The VA Diffusion of
Excellence Hub is
utilized by two
initiatives to identify
and diffuse best
practices across the
enterprise
The VA Diffusion of
Excellence Hub is
utilized by two
initiatives to identify
and diffuse best
practices across the
enterprise
Diffusion across the
enterprise is
measured through
the Diffusion Meter
Diffusion across the
enterprise is
measured through
the Diffusion Meter
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Using these processes, VHA is implementing 300
ongoing replications at over 70 facilities.
As of August 29, 201616
Questions/Comments
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Appendix
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Leveraging the Model to Scale Best
Practices in Multidisciplinary Cancer Care
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Meeting Veterans Where They Are
• There are 5.3 million rural and highly rural Veterans in the U.S., with three
million enrolled in the VA health care system
– 57 percent of rural Veterans are enrolled in the VA health care system -
significantly higher than the 36 percent enrollment rate of urban Veterans
• Rural Veterans tend to be older, and can be medically more complex:
Specific challenges for rural Veterans include:
– Higher poverty rates
– Greater geographic and distance barriers (to VA and non-VA facilities)
– Limited broadband internet access
• Rural cancer patients can have poor access to comprehensive oncology
resources
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Given these factors, VA has developed innovative solutions to
provide outstanding cancer care to rural Veterans.
Given these factors, VA has developed innovative solutions to
provide outstanding cancer care to rural Veterans.
Gold Status Practice: Virtual Liver Cancer Tumor Board
Overview
Challenge
Limited availability of specialty multidisciplinary clinical staff in individual VA Medical Centers to address abnormal liver imaging in high-risk individuals
This issue results in unnecessary biopsies, delayed diagnoses of liver cancer and delayed referrals for loco-regional treatments, resection, or transplant
Solution
Virtual Liver Cancer Tumor Boards, supported by telehealth and web-based technology, allow for pooling of staff across facilities to provide more timely care to liver cancer patients
Results
Standardized imaging improved accuracy and quality of images captured
Reduced liver biopsy rate from current rate of 18% to the national standard of less than 10%
Decreased time from liver cancer diagnosis to treatment from current average of 75 days to 30 days or less
Improved communication and coordination of care between Medical Centers
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Originating Facility
Corporal Michael J. Crescenz VA Medical Center (Philadelphia, PA)
Setting
•Urban/Rural Mix; VISN 4 covers a smaller geographic area
•Hub & Spoke facilities less than 150 miles apart
Model: Hub & Spoke
•Hub: Philadelphia VAMC
•Spokes: Allentown, Lebanon, Pittsburgh, Wilkes-Barre
Supporting Technology
•Computerized Patient Record System (CPRS)
•Microsoft Access
•Microsoft SharePoint
•Polycom Telehealth Bridge
•Regional shuttle between facilities
Implementing Facility
G.V. (Sonny) Montgomery VA Medical Center (Jackson, MS)
Setting
•Urban/Rural Mix; VISN 16 covers a wide geographic area
•Hub & Spoke facilities 250+ miles apart
Model: Hub & Spoke
•Hub: Little Rock VAMC
•Spoke: Jackson VAMC
Supporting Technology
•Computerized Patient Record System (CPRS)
•Microsoft Access
•Microsoft SharePoint
•Polycom Telehealth Bridge
Implementation steps
•Standardized liver imaging protocols
•Developed telehealth service agreement including required personnel, primary and secondary stop codes for interventional radiology
•Completed resource request for Liver Cancer Coordinator
•Researching options for transportation
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Gold Status Practice: Virtual Liver Cancer Tumor Board
Adaptation and Implementation
National Deployment Plan (1 of 3)
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Pre-Diffusion
of Excellence
Post-Diffusion
of Excellence
National Deployment Plan (2 of 3)A
sse
ss C
urr
en
t S
tate
Determine how virtual tumor boards are used across the agency
•VHA Cancer Care
Survey open July 29 –
August 25, 2016;
Included 4-part
question on tumor
board use. See survey
questions on slide 22.
SM
E R
ev
iew
Assemble SMEs to review models and methods used for virtual tumor boards and recommend options for broader use
Pla
n D
eve
lop
me
nt
Develop plan based on selected option
De
plo
ym
en
t
National Deployment
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National Deployment Plan (3 of 3)
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Virtual Tumor Board
26As of August 29, 2016