Evaluation of a National VA Organizational Structure Redesign

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Justification: Our operational partner, the Office of the Assistant Deputy Under Secretary for Health for Clinical Operations (10NC), requested a QUERI partnered evaluation of a redesign of the national clinical services organizational structure, called Integrated Clinical Communities (ICC). Gaps Addressed: Prior to this proposal, QUERI start-up funds were used to conduct interviews with VHACO and VISN leaders in order to articulate the logic model underlying the ICC reorganization, and identify validated survey measures that can be used to evaluate the ICC implementation at the VAMC and VISN levels of analysis. However, our interviews revealed that the VAMC-level logic model was not as well developed as the VISN-level and VHACO-level logic model. This is due in part to a decision to not mandate a specific reorganization at the VAMC level of analysis based on lessons learned in the 1990s service line reorganization. Thus, there are likely to be a wide range of VAMC-level implementations of the ICCs. At the VHACO level of analysis, the ICC implementation is potentially threatened by overlapping roles and responsibilities between the ICC leads and the existing VHACO program offices. Innovativeness: The opportunity to improve policy development and implementation in VHA occurs rarely. The last large-scale organizational redesign was the VISN reorganization conducted twenty years ago. Our team includes an evaluator of the prior VISN reorganization. The proposed evaluation will provide the timely feedback needed to guide 10NC regarding how to ensure that this work improves care for Veterans. Specific Aims: The proposed 18-month program evaluation has two specific aims: (1) Field, evaluate and elaborate the ICC survey, and (2) determine how the VHACO ICC implementation achieves the expectations of the logic model. Project Methods: The proposed evaluation will use observational methods. A quantitative survey developed with QUERI start-up funds will measure the intermediate outcomes for each of the six ICCs at the facility level and VISN level. Aim 1 will use qualitative interviews to better understand the logic model for the VAMC-level implementation. Aim 2 will use qualitative interviews to evaluate how the ICC implementation at the VHACO-level achieves the expectations of the ICC logic model.