Frontline Huddling for Quality Improvement Implementation Strategy Learning Network Hub

以员工为基础的举措对病人护理的质量有着巨大的影响，特别是当变化 在前线实施。然而，许多质量改进（QI）计划没有充分强调关键的 在QI工作中向一线工作人员学习和参与的重要性。我们开发了一个独特的，基于证据的 实施框架，称为学习（从亮点中学习，观察，在秘密会议中协作， 保持一口大小）来解决这个差距。该中心支持VA一线提供者，经理， 运营人员，以及VHA卓越传播倡议金牌会员（例如， 住院精神卫生、家庭初级保健、社区生活中心等）在使用 实施框架，以改善前线护理。该中心利用医疗保健研究所 改进（IHI）突破系列合作模式在一个完全虚拟的培训计划，利用 一个正在进行的国家虚拟项目的材料。该中心有以下目标。(1)培训参与者， (a)（B）其有效实施（包括快速周期改进）， 使用IHI突破系列合作模式进行一系列虚拟培训。(2)促进行动期 在培训期间，参与者使用快速的 周期改进技术，并衡量其干预措施的影响。该中心利用广泛的 VA资助的研究，并建立在现有的，以证据为基础的过程，强调的重要性， 基于优势的学习，协作解决问题和结构化观察。在此基础上 首先在6个试点VA CLC中制定和实施，然后通过并与 老年医学与延续照护-一旦全面实施， 在结构、过程和结果中产生有记录的积极影响。中心的两个培训目标 将帮助参与者在他们的环境中实现快速循环改进，并确保参与者遵守 的核心原则。虚拟（基于网络研讨会的交互式）培训将教授有关网络捆绑包的内容 及其实施。学习课程将穿插行动阶段，参与者将尝试 他们学到了什么。指导将通过电子邮件和Pulse网站以及每月的辅导电话进行真实的时间。 培训课程侧重于可持续发展框架及其实施的具体内容， 如何建立和维持领导和组织实践以及QI基础设施以实现高绩效 在护理的第一线。因此，该中心通过以下方式实现改进：（1）培训参与者了解有效的 实践，并让参与者分享他们实施这些实践的经验;（2）使用行动 让参与者尝试他们所学到的东西。通过实施实践和向同行学习 参与者不仅可以从讲师那里学习，还可以通过学习同事如何克服困难来有效地利用时间。 并利用可持续发展的实施做法成功地推广其干预措施。这加速 传播并促进快速采用有效的流程。

Staff-based initiatives have tremendous influence on the quality of patient care, particularly when changes are implemented at the frontline. Yet many quality improvement (QI) programs underemphasize the crucial importance of learning from and engaging frontline staff in QI efforts. We developed a unique, evidence-based implementation framework known as LOCK (Learn from the bright spots, Observe, Collaborate in huddles, and Keep it bite-size) to address this gap. This Hub supports practical training for VA frontline provider, manager, operations staff, and VHA Diffusion of Excellence Initiative Gold Status Fellows (in the areas of, for example, inpatient mental health, home based primary care, Community Living Centers [CLCs], etc.) in using the LOCK implementation framework to improve care at the frontlines. The Hub uses the Institute for Healthcare Improvement (IHI) breakthrough series collaborative model in a completely virtual training program, leveraging materials from an ongoing national virtual program. The Hub has the following goals. (1) Train participants on (a) the fundamentals of LOCK and (b) its effective implementation (including rapid cycle improvement) through a series of virtual trainings using the IHI breakthrough series collaborative model. (2) Facilitate action periods between trainings in which participants pilot the LOCK-based implementation of systemic changes using rapid cycle improvement techniques and measure the impact of their interventions. The Hub capitalizes on extensive VA-funded research and builds on existing, evidence-based processes emphasizing the importance of strengths-based learning, collaborative problem-solving, and structured observation. Based on this, we developed and implemented—first in 6 pilot VA CLCs, then in all CLCs nationally through and with the Office of Geriatrics and Extended Care—the LOCK implementation framework. When fully implemented, LOCK produces documented positive effects in structures, processes, and outcomes. The Hub's two training goals will help participants achieve rapid-cycle improvement in their settings and ensure that participants adhere to the core LOCK principles. The virtual (interactive webinar-based) trainings will teach about the LOCK bundle and its implementation. The learning sessions will be interspersed with action periods in which participants trial what they learn. Mentoring will take place real time via email and a Pulse site and in monthly coaching calls. The training curriculum focuses on specifics of the LOCK framework and its implementation, concentrating on how to build and sustain leadership and organizational practices and a QI infrastructure for high performance at the frontlines of care. The Hub thus achieves improvement by (1) training participants about effective practices and having participants share their experiences implementing these practices and (2) using action periods to enable participants to trial what they learn. By implementing practices and learning from their peers rather than only from instructors, participants efficiently use their time by learning how colleagues overcame barriers and successfully spread their interventions using LOCK implementation practices. This accelerates spread and promotes rapid adoption of effective processes.