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

对退伍军人医疗保健的预期影响：医疗保健服务的普及，活动，研究和 知识（SHAARK）合作评估中心（PEC）旨在提供快速和频繁的反馈 向VHA卓越传播（DEI）合作伙伴提供以下服务：1）解决旨在增加参与的因素， DEI; 2）帮助提高VA设施内的组织准备，以成功实施 有希望的做法; 3）解决与成功相关的关键背景因素 在VA设施实施黄金状态做法。一个预期的评价结果是， DEI合作伙伴提供有效的“个性化实施”（组织级和个人级）的能力 以人为本的设计）的有前途的做法。 项目背景：DEI的目标是：1）使员工能够在护理方面进行创新 2）使实施和传播承诺的过程制度化 实践;和3）最大限度地减少整个VA实践中的负面变化。DEI开始于征求 前线退伍军人事务部工作人员的“有前途的做法”，旨在解决副部长的主要优先事项， 健康2015年12月，提交了260项“有希望的做法”，随后由主题专家 选择40名半决赛选手和20名决赛选手。决赛选手然后提交给设施和退伍军人综合 服务网络（VISN）董事通过“鲨鱼坦克”，在此期间，参与董事（即，鲨鱼） “投标”资源，用于实施他们选择的决赛“有希望的做法”。13个被选中的人 这些做法被指定为“黄金级”最佳做法。支持编写执行材料， 已向启动该实践的研究中心（“黄金状态设施”）提供了 为17个选定实施“黄金地位”做法的地点提供了“实施设施”。过程 随后，在VA中实施这些实践的385个实施项目开始， 设施自那时以来，该机构已在战略一体化办公室内制度化，该办公室向 卫生部负责组织卓越的副部长帮办。 项目目标：SHAARK PEC的总体目标是了解DEI过程的影响， 它提供了一个国家基础设施，以支持自下而上的方法， 前线人员，然后在中央支持下实施。目标1和目标2侧重于提高妇女地位倡议的参与 和采用决定的有前途的做法。具体而言，目标1是确定与下列因素有关的因素： 参与DEI。目的2是研究鲨鱼在选择投标资源时的决策过程 实施黄金状态实践，并将流程与感知到的组织准备情况相关联， 变更（ORC）。目标3侧重于实施黄金地位做法的过程。目标3： 进行评价，以了解对执行设施内执行成功的影响， 选择有机地实施最佳做法的基层设施。最后，目标4的重点是 在DEI的整个生命周期中综合研究结果。目标4将利用定性比较分析 确定更广泛传播和成功实施黄金地位做法的途径的方法。 项目方法：我们将进行一个基于理论的，评估的DEI主要利用综合 结合组织准备理论的实施研究框架（CFIR） 为了改变。我们将使用定性（半结构化访谈）和定量方法（主要是 定性比较分析），以解决目标。

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.