Virtual Quality Improvement Training for VHA Teams: The Learn. Engage. Act. Process. (LEAP) Program

背景我们的团队在弗吉尼亚州进行并发表了多项实施评估;同样， 一再查明对执行成功产生负面影响的一系列核心障碍。主要差距 与执行不佳或失败相关的问题都与统一的 实施研究框架（CFIR）：缺乏规划、参与、反思和评估 执行进度。质量改进（QI）合作者使用的方法成功地帮助了 当地团队实施变革。然而，这种方法往往是资源密集型的，需要出差和休假 为期多天的会议和专家主持人的实地访问。一种结构化、可扩展、经济高效的方法， 需要在一线临床医生和工作人员中建立实施变革的技能。我们的QUERI计划 开发了“学习。开火法过程。”（LEAP）计划来满足这一需求。 重要性/影响斯通博士，负责VHA的执行官已经成为一个高可靠性 组织（HRO）是VHA的首要任务。人力资源管理的三大支柱之一，也是必要的基础能力 学习型卫生系统的关键是持续过程改进，所有员工都定期在一起工作 使用QI方法可以改善临床过程和实践。员工必须具备 必要的技能，并感到有能力创新和实施QI计划，以最终影响退伍军人的 健康和幸福。这些技能对于实施循证创新至关重要。但在 对来自20个VHA医疗中心的109名员工进行了基线调查，受访者对他们的QI进行了评分， 在六种气功方法中的五种中，六分制中的技能低于三分。实践学习气法 对于实现HRO目标并成为一个学习型组织来说， 卫生系统。 创新我们的团队专门开发了LEAP，以帮助团队在忙碌的环境中实施有效的变革 临床环境。LEAP在提供团队立即应用的新内容的小“咬”方面是独一无二的 在他们自己的临床环境中实现他们最优先考虑的目标。LEAP借鉴课程 由HarvardX和医疗保健改善研究所（IHI）开发，包括四个基于证据的 实施战略：1）创建学习协作，2）评估准备情况并确定障碍， 促进者，3）审计并提供反馈，以及4）进行周期性的小型变更测试。LEAP节省成本 因为辅导是使用具有在线协作平台支持的网络研讨会平台来提供的。飞跃 已完全开发并打包，可交付给更多团队。 具体目标我们有两个目标：目标1）为VHA提供质量改进方法的LEAP培训 临床团队，帮助诊所实现VHA的HRO目标，即对退伍军人零伤害;以及目标2） 使用培训师培训模式培训更多的LEAP教练，以扩大对更多团队的影响。 方法我们将与付费合作伙伴合作，为改进团队提供LEAP。我们的IHI培训 教练将带领团队通过LEAP的结构化课程：1）组建团队， 改进目标（第1-10周）; 2）制定项目章程，包括结果、过程和平衡 成功衡量标准（第11-14周）; 3）执行和测试变更并监控进度（第15-26周）; 4） 介绍成果，包括吸取的经验教训（第24-25周）; 5）为今后的变革周期制定计划。我们还将 识别和培训新教练，为更多团队提供LEAP。我们将使用事前事后评估， 和文件审查，以评估培训中心对个人、团队和卫生系统成果的影响， 以下领域：对LEAP的满意度、技能获得、对工作的影响和确定的临床结果。

Background Our team has conducted and published multiple implementation evaluations in VA; the same core set of barriers are repeatedly identified that negatively impact implementation success. Key gaps associated with poor or failed implementation are related to the Process domain described by the Consolidated Framework for Implementation Research (CFIR): lack of planning, engaging, and reflecting on and evaluating progress of implementation. Methods used by quality improvement (QI) collaboratives are successful in helping local teams implement change. Yet, this approach tends to be resource-intensive, requiring travel and time off for multi-day sessions and site visits by expert facilitators. A structured scalable, cost-effective approach for building skills to implement change is needed among frontline clinicians and staff. Our QUERI program developed the “Learn. Engage. Act. Process.” (LEAP) Program to address this need. Significance/Impact Dr. Stone, the Executive in Charge for VHA has made becoming a High Reliability Organization (HRO) a top priority for VHA. One of three pillars of HRO and a foundational capability necessary for learning health systems is Continuous Process Improvement, where all employees routinely work together using QI methods make improvements in clinical processes and practices. Employees must have the necessary skills and feel empowered to innovate and implement QI initiatives to ultimately impact Veterans’ health and well-being. These same skills are critical for implementing evidence-based innovations. However, in baseline surveys administered to 109 employees from 20 VHA medical centers, respondents rated their QI skills below three on a six-point scale in five of six categories of QI methods. Hands-on learning of QI methods for employees within everyday clinical work is essential for achieving HRO goals and to become a learning health system. Innovation Our team developed LEAP specifically to help teams implement effective changes within busy clinical settings. LEAP is unique in providing small “bites” of new content which teams immediately apply within their own clinical setting to achieve aims that are their highest priority. LEAP draws on curriculum developed by HarvardX and the Institute for Healthcare Improvement (IHI) and comprises four evidence-based implementation strategies: 1) create a learning collaborative, 2) assess for readiness and identify barriers and facilitators, 3) audit and provide feedback, and 4) conduct cyclical small tests of change. LEAP is cost-saving because coaching is provided using a webinar platform with support of an online collaboration platform. LEAP is fully developed and packaged for delivery to more teams. Specific Aims We have two aims: Aim 1) Provide LEAP training in quality improvement methods to VHA clinical teams, helping clinics achieve VHA’s HRO goal of Zero Preventable Harms to Veterans; and Aim 2) Train additional LEAP coaches using a train-the-trainer model to expand reach to more teams. Methodology We will work with paying partners to deliver LEAP to improvement teams. Our IHI-trained coaches will lead teams through LEAP’s structured curriculum to: 1) form their team and develop an improvement aim (weeks 1-10); 2) develop a project charter that includes outcome, process, and balancing measures of success (weeks 11-14); 3) execute and test the change and monitor progress (weeks 15-26); 4) present results, including lessons learned (weeks 24-25); and 5) plan for future cycles of change. We will also identify and train new coaches to deliver LEAP to more teams. We will use pre-post assessments, interviews and document review to evaluate the training hub impact on individual, team, and health system outcomes in the following domains: satisfaction with LEAP, skill acquisition, impact on work and identified clinical outcomes.