Spreading Healthcare Access, Activities, Research and Knowledge (SHAARK) PEC

对退伍军人医疗保健的预期影响：医疗保健服务的普及、活动、研究和 知识(SHAARK)合作评估中心(PEC)旨在提供快速、频繁的反馈 向VHA卓越传播(DEI)合作伙伴1)解决旨在增加参与 Dei；2)帮助提高组织对退伍军人管理局设施内变化的准备，以成功实施 有前景的实践；以及3)解决与成功相关的关键背景因素 在退伍军人管理局设施实施黄金地位做法。预期的评价结果是增加 Dei合作伙伴提供有效的“个性化实施”(组织级和人员级)的能力 以人为本的设计)有前途的实践。 项目背景：Dei的目标是：1)赋予员工在护理方面的创新能力 和行政进程，2)使执行和传播有希望的进程制度化 实践；以及3)最大限度地减少退伍军人事务部实践中的负面差异。神灵降临以征集 退伍军人事务部前线工作人员为解决副局长的主要优先事项而提出的“有希望的做法” 健康。2015年12月，提交了260份《有希望的做法》，随后提交了专题专家 评选出40名半决赛选手和20名决赛选手。最终入围者随后被提交给设施和退伍军人综合医院 服务网络(VISN)导演通过“鲨鱼缸”，在此期间，参与的导演(即鲨鱼) 竞标资源，用于实施入围决赛的有希望的做法，他们选择。入选的13个有希望的人 这些做法被指定为“黄金地位”最佳做法。为编制执行材料提供了支持 向发起这一做法的网站提供了支持(“黄金地位设施”)，并提供了便利的支持 向选定的17个地点提供“黄金地位”做法(“实施设施”)。这个过程 在退伍军人事务部实施这些做法的工作随后开始，在100家企业中实施了385项 设施。自那以后，Dei已在战略整合办公室内制度化，该办公室向 卫生局副秘书长负责组织的卓越表现。 项目目标：SHAARK PEC的总体目标是了解Dei过程的影响， 它提供了国家基础设施来支持自下而上的方法，从 前线工作人员，然后在中央支助下实施。目标1和目标2侧重于Dei的参与 以及对有前景的实践的采用决定。具体地说，目标1是确定与 在神灵的参与。目标2是检查鲨鱼在选择竞标资源时的决策过程 实施黄金地位实践并与感知的组织就绪性相关的流程 更改(ORC)。目标3侧重于实施黄金地位做法的过程。目标3是进行 流程评估，以了解实施设施内对实施成功的影响以及 选择有机实施最佳实践的基层设施。最后，目标4侧重于 综合整个环境和经济发展部生命周期的调查结果。目标4将利用定性比较分析 确定更广泛传播和成功实施黄金地位做法的途径。 项目方法：我们将对DEI进行基于理论的评估，利用综合的 结合组织准备理论的实施研究框架(CFIR) 找回零钱。我们将使用定性(半结构化访谈)和定量(主要是 定性比较分析)，以解决目标。

Anticipated Impacts on Veteran’s Healthcare: The Spreading Healthcare Access, Activities, Research and Knowledge (SHAARK) Partnered Evaluation Center (PEC) is designed to provide rapid and frequent feedback to VHA Diffusion of Excellence (DEI) partners by 1) addressing factors aimed at increasing participation in the DEI; 2) helping increase organizational readiness for change within VA facilities to successfully implement promising practices; and 3) addressing key contextual factors that are associated with successful implementation of gold status practices at VA facilities. An anticipated evaluation outcome is the increased ability of DEI partners to provide effective “personalized implementation” (organizational-level and person-level human centered design) of promising practices. Project Background: The objectives of the DEI are to: 1) empower employees to develop innovations in care and administrative processes, 2) institutionalize the process for implementing and spreading promising practices; and 3) minimize negative variation in practices across the VA. The DEI began with solicitation of “promising practices” from front-line VA staff designed to address key priorities of the Under Secretary for Health. In December 2015, 260 “promising practices” were submitted followed by subject matter expert selection of 40 semifinalists and 20 finalists. Finalists were then presented to facility and Veterans Integrated Service Network (VISN) directors through a “shark tank,” during which the participating directors (i.e., sharks) “bid” resources for implementation of the finalist “promising practices” they chose. The 13 chosen promising practices were designated as “gold status” best practices. Support to develop implementation materials has been provided to the sites that initiated the practice (“gold status facilities”) and facilitated support has been provided to the 17 sites selected to implement “gold status” practices (“implementation facilities”). The process of implementing these practices across the VA has subsequently begun with 385 implementations across >100 facilities. The DEI has since been institutionalized within the Office of Strategic Integration, which reports to the Deputy Under Secretary for Health for Organizational Excellence. Project Objectives: The overall goal of the SHAARK PEC is to understand the impact of the DEI’s process, which provides a national infrastructure to support a bottom-up approach eliciting promising practices from frontline staff which are then implemented with central support. Aims 1 and 2 are focused on DEI participation and adoption decisions for promising practices. Specifically, aim 1 is to identify factors associated with participation in the DEI. Aim 2 is to examine shark decision making processes when choosing to bid resources for implementation of gold status practices and relate processes to perceived organizational readiness for change (ORC). Aim 3 is focused on the process of implementing gold status practices. Aim 3 is to conduct process evaluations to understand influences on implementation success within implementing facilities and grassroots facilities that choose to organically implement best practices. Finally, aim 4 is focused on the synthesis of findings across the full life-cycle of the DEI. Aim 4 will utilize qualitative comparative analysis methods to identify pathways toward broader diffusion and successful implementation of gold status practices. Project Methods: We will conduct a theory-based, evaluation of the DEI primary utilizing the Consolidated Framework for Implementation Research (CFIR) in combination with the Theory for Organizational Readiness for Change. We will utilize both qualitative (semi-structured interviews) and quantitative methods (primarily qualitative comparative analysis) to address the aims.