Frontline Huddling for Quality Improvement Implementation Strategy Learning Network Hub

以工作人员为基础的倡议对患者护理的质量有巨大的影响，特别是在 在前线实施。然而，许多质量改进(QI)计划低估了关键 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、以证据为基础的 称为锁定(Lock)的实现框架(学习亮点、观察、挤在一起协作，以及 保持一定的规模)，以弥补这一差距。该中心支持对退伍军人管理局一线提供商、经理、 业务人员和VHA卓越扩散计划金牌研究员(例如，在以下领域) 住院精神健康、居家初级保健、社区生活中心[CLCs]等)在使用锁时 改善前线护理的实施框架。该中心使用医疗保健研究所 改进(IHI)在完全虚拟的培训计划中的突破性系列协作模式，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)培训参与者 (A)锁定的基本原则和(B)通过以下途径有效实施(包括快速改进周期) 采用IHI突破性系列协同模式进行的系列虚拟培训。(2)便利行动期限 在培训期间，参与者使用RAPID引导基于锁的系统更改的实施 循环改进技术，并衡量其干预措施的影响。该中心利用广泛的 由退伍军人事务部资助的研究，并建立在现有的、以证据为基础的过程基础上，强调 以强项为基础的学习、协作解决问题和结构化观察。基于此，我们 制定和实施--首先在6个退伍军人事务部试点项目中实施，然后在全国范围内通过和与 老年病和长期护理--锁实施框架。完全实现后，锁定 在结构、过程和结果方面产生记录在案的积极影响。该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 核心锁定原则。虚拟(基于交互式网络研讨会)培训将教授有关锁束的知识 以及它的实施。学习课程将穿插在参与者试用的行动时段中 他们学到了什么。指导将通过电子邮件和Pulse网站以及每月的指导电话实时进行。 培训课程侧重于锁框架及其实现的具体内容，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。中心因此通过以下方式实现改进：(1)培训参与者关于 实践和让参与者分享他们实施这些实践的经验和(2)使用行动 让参与者能够尝试他们所学到的东西的时间。通过实施实践和向同行学习 不只是从讲师那里，参与者通过学习同事如何克服困难来有效地利用他们的时间 在这方面，儿童基金会设立了障碍，并成功地推广了他们的干预措施，采用了锁定实施做法。这加速了 推广和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.