Frontline Huddling for Quality Improvement Implementation Strategy Learning Network Hub

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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.