Frontline Huddling for Quality Improvement Implementation Strategy Learning Network Hub

以员工为基础的举措对患者护理质量具有巨大影响，特别是当发生变化时 落实在第一线。然而，许多质量改进 (QI) 计划都低估了关键的因素 向一线员工学习并让他们参与 QI 工作的重要性。我们开发了一种独特的、基于证据的 称为 LOCK 的实施框架（从亮点中学习、观察、集中协作以及 保持小规模）来弥补这一差距。该中心支持 VA 一线提供者、经理、 运营人员和 VHA 卓越传播计划金牌研究员（例如，在以下领域） 住院患者心理健康、家庭初级保健、社区生活中心 [CLC] 等）使用 LOCK 改善前线护理的实施框架。该中心使用医疗保健研究所 完全虚拟培训计划中的改进 (IHI) 突破性系列协作模型，利用 来自正在进行的国家虚拟计划的材料。该中心有以下目标。 (1) 对参与者进行培训 (a) LOCK 的基本原理以及 (b) 通过以下方式有效实施（包括快速周期改进）： 使用 IHI 突破性系列协作模型的一系列虚拟培训。 (2) 促进行动期 在培训期间，参与者使用快速试验基于 LOCK 的系统变革实施 周期改进技术并衡量其干预措施的影响。该中心利用广泛 VA 资助的研究以现有的、基于证据的流程为基础，强调了 基于优势的学习、协作解决问题和结构化观察。基于此，我们 制定并实施——首先在 6 个试点 VA CLC 中，然后通过与办公室一起在全国所有 CLC 中实施 老年病学和延伸护理——LOCK 实施框架。完全实施后，LOCK 在结构、流程和结果方面产生有记录的积极影响。该中心的两个培训目标 将帮助参与者实现其环境的快速循环改进，并确保参与者遵守 核心 LOCK 原则。虚拟（基于交互式网络研讨会）培训将教授 LOCK 捆绑包 及其实施。学习课程将穿插有参与者尝试的行动期 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实时进行。 培训课程重点关注 LOCK 框架及其实施的细节，重点是 如何建立和维持领导力和组织实践以及 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 (1) 对参与者进行有效培训来实现改进 实践并让参与者分享实施这些实践的经验以及 (2) 使用行动 让参与者能够尝试他们所学到的知识。通过实施实践并向同行学习 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自己的时间 障碍并使用 LOCK 实施实践成功传播干预措施。这加速了 传播并促进有效流程的快速采用。

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.