Spreading Healthcare Access, Activities, Research and Knowledge (SHAARK) PEC

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Anticipated Impacts on Veteran’s Healthcare: The Spreading Healthcare Access, Activities, Research and Knowledge (SHAARK) Partnered Evaluation Center (PEC) is designed to provide rapid and frequent feedback to VHA Diffusion of Excellence (DEI) partners by 1) addressing factors aimed at increasing participation in the DEI; 2) helping increase organizational readiness for change within VA facilities to successfully implement promising practices; and 3) addressing key contextual factors that are associated with successful implementation of gold status practices at VA facilities. An anticipated evaluation outcome is the increased ability of DEI partners to provide effective “personalized implementation” (organizational-level and person-level human centered design) of promising practices. Project Background: The objectives of the DEI are to: 1) empower employees to develop innovations in care and administrative processes, 2) institutionalize the process for implementing and spreading promising practices; and 3) minimize negative variation in practices across the VA. The DEI began with solicitation of “promising practices” from front-line VA staff designed to address key priorities of the Under Secretary for Health. In December 2015, 260 “promising practices” were submitted followed by subject matter expert selection of 40 semifinalists and 20 finalists. Finalists were then presented to facility and Veterans Integrated Service Network (VISN) directors through a “shark tank,” during which the participating directors (i.e., sharks) “bid” resources for implementation of the finalist “promising practices” they chose. The 13 chosen promising practices were designated as “gold status” best practices. Support to develop implementation materials has been provided to the sites that initiated the practice (“gold status facilities”) and facilitated support has been provided to the 17 sites selected to implement “gold status” practices (“implementation facilities”). The process of implementing these practices across the VA has subsequently begun with 385 implementations across >100 facilities. The DEI has since been institutionalized within the Office of Strategic Integration, which reports to the Deputy Under Secretary for Health for Organizational Excellence. Project Objectives: The overall goal of the SHAARK PEC is to understand the impact of the DEI’s process, which provides a national infrastructure to support a bottom-up approach eliciting promising practices from frontline staff which are then implemented with central support. Aims 1 and 2 are focused on DEI participation and adoption decisions for promising practices. Specifically, aim 1 is to identify factors associated with participation in the DEI. Aim 2 is to examine shark decision making processes when choosing to bid resources for implementation of gold status practices and relate processes to perceived organizational readiness for change (ORC). Aim 3 is focused on the process of implementing gold status practices. Aim 3 is to conduct process evaluations to understand influences on implementation success within implementing facilities and grassroots facilities that choose to organically implement best practices. Finally, aim 4 is focused on the synthesis of findings across the full life-cycle of the DEI. Aim 4 will utilize qualitative comparative analysis methods to identify pathways toward broader diffusion and successful implementation of gold status practices. Project Methods: We will conduct a theory-based, evaluation of the DEI primary utilizing the Consolidated Framework for Implementation Research (CFIR) in combination with the Theory for Organizational Readiness for Change. We will utilize both qualitative (semi-structured interviews) and quantitative methods (primarily qualitative comparative analysis) to address the aims.