Evaluation of a National VA Organizational Structure Redesign

国家退伍军人管理局组织结构重新设计的评估

• 批准号: 10188100
• 负责人: Justin K. Benzer
• 金额: --
• 依托单位: OLIN TEAGUE VETERANS CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-10-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10188100
• 关键词: Address; Affect; Attention; Caring; Centers for Disease Control and Prevention (U.S.); Clinical; Clinical Services; Communication; Communities; Community Surveys; Community of Practice; Complex; Data; Development; Diagnostic; Ensure; Evaluation; Feedback; Foundations; Funding; Goals; Health; Individual; Information Technology; Interview; Leadership; Logic; Measurement; Measures; Mental Health; Methodology; Methods; Modeling; Modernization; Operative Surgical Procedures; Outcome; Patient Care; Patient-Focused Outcomes; Phase; Policies; Policy Developments; Positioning Attribute; Primary Health Care; Program Evaluation; Qualitative Methods; Rehabilitation therapy; Resources; Role; Services; Standardization; Structure; Surveys; System; Time; Variant; Veterans; Veterans Health Administration; Work; base; community based practice; community organizations; design; development policy; expectation; experience; improved; innovation; medical specialties; operation; organizational structure; programs

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.

理由：我们的业务伙伴，卫生局助理副局长办公室 对于临床操作（10NC），要求QUERI合作评估国家 临床服务组织结构，称为综合临床社区（ICC）。 弥补的差距：在提出这一建议之前，QUERI的启动资金被用于与下列人员进行访谈： VHACO和VISN领导人，以便阐明ICC重组的逻辑模型， 确定有效的调查措施，可用于评估弗吉尼亚州军事指挥中心的ICC实施情况 和VISN水平的分析。然而，我们的采访显示，VAMC级逻辑模型并不是 以及发达的VISN级和VHACO级逻辑模型。这部分是由于决定 不要求在VAMC一级根据在 1990年，公司重组。因此，很可能存在广泛的VAMC水平 ICC的实施。在VHACO分析级别，ICC实现可能 由于ICC领导和现有VHACO之间的角色和责任重叠， 方案办公室。 创新性：改善VHA政策制定和实施的机会出现 很少。最后一次大规模的组织重新设计是2010年进行的VISN重组。 年前我们的团队包括之前VISN重组的评估人员。提出的评价 将及时提供必要的反馈，以指导10NC如何确保这项工作得到改进 照顾退伍军人。 具体目标：拟议的18个月计划评估有两个具体目标：（1）实地评估 并详细阐述ICC调查，以及（2）确定VHACO ICC实施如何实现 逻辑模型的期望。 项目方法：拟议的评价将使用观察方法。定量调查 用QUERI启动资金开发的一个评估模型将衡量六个ICC中每一个的中期成果 在设施级别和VISN级别。目标1将使用定性访谈来更好地理解逻辑 VAMC级实现的模型。目标2将使用定性访谈来评估ICC如何 VHACO级的实现实现了ICC逻辑模型的期望。