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

背景我们的团队在退伍军人管理局进行并发布了多项实施评估；相同 反复查明对执行成功产生负面影响的一组核心障碍。关键差距 与糟糕或失败的实现相关联的是与Consolated 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)协作组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 供专家调解人进行为期数天的会议和现场访问。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培养实施变革的技能。我们的Queri计划 开发了“学习”。交战。行动起来。过程。“(LEAP)计划以满足这一需求。 意义/影响斯通博士，负责VHA的执行人员已成为高度可靠的 组织(HRO)是VHA的首要任务。人力资源组织的三大支柱之一和必要的基础能力 对于学习卫生系统来说，是持续的过程改进，所有员工经常在一起工作 使用QI方法改进临床流程和实践。员工必须拥有 必要的技能和感觉有能力创新和实施QI计划，最终影响退伍军人的 健康和幸福。这些技能对于实施基于证据的创新至关重要。但是，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进行了评级 在六种QI方法中的五种中，技能低于3分(满分为6分)。QI方法的实践学习 对于员工来说，日常临床工作对于实现人力资源目标和成为一名学习型员工至关重要 卫生系统。 创新我们的团队专门开发了Leap，以帮助团队在繁忙的时间内实施有效的更改 临床环境。Leap在提供团队立即应用的小部分新内容方面是独一无二的 在他们自己的临床环境中实现他们最优先考虑的目标。Leap利用课程 由哈佛X和医疗保健改进研究所(IHI)开发，包括四个基于证据的 实施战略：1)创建协作学习，2)评估就绪性并确定障碍和 促进者，3)审计和提供反馈，以及4)对变化进行周期性的小测试。Leap节省成本 因为辅导是使用支持在线协作平台的网络研讨会平台来提供的。飞跃 是完全开发和打包的，以便交付给更多的团队。 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飞跃培训 临床团队，帮助诊所实现VHA的HRO目标，即对退伍军人零预防伤害；以及目标2) 使用培训教练员的模式培训更多的Leap教练，以扩大到更多团队。 方法我们将与付费合作伙伴合作，为改进团队提供LEAP。我们受过IHI训练的 教练将带领团队通过LEAP的结构化课程：1)组建他们的团队，并制定 改进目标(第1-10周)；2)制定包含结果、过程和平衡的项目章程 成功的衡量标准(第11-14周)；3)执行和测试变更并监测进度(第15-26周)；4) 介绍成果，包括吸取的经验教训(第24-25周)；以及5)为未来的变革周期制定计划。我们还将 确定并培训新的教练，为更多的团队提供Leap。我们将使用岗位前评估、面谈 和文档审查，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.