Leading Healthcare Improvement: Leadership Training for Applying ImprovementStrategies

医疗保健系统是复杂的;持续改善医疗保健质量需要使用 有针对性的实施战略。然而，如果没有一个有效的执行战略， 了解不同的组织和领导背景，可以改善医疗保健， 由于部分实施或可持续性有限而不成功。传播临床最佳实践 需要医疗保健系统各个层面的有效领导者，包括一线提供者和运营者。 工作人员临床医生和工作人员谁是“积极和有影响力的公民的医疗保健社区”能够 影响医疗改革。此外，受过领导原则培训的卫生专业人员， 改进策略能够更好地将临床最佳实践转化为当地医疗保健环境， 有效地管理人际关系，培养传播和维持所需的伙伴关系 改进.尽管教学实施策略和领导的必要性和协同作用 这些方法通常是孤立地教授的。我们提出了一个创新的培训计划 一个多方面的实施战略，整合了基于证据的改进的力量， 战略（改进模型）和变革管理的领导技能（领导变革）。 VA质量学者（VAQS）计划，在11个VA医疗中心的国家培训计划 在整个美国，培训跨专业的临床医生领导者，包括医生，护士，临床 心理学家，药剂师和其他医疗保健专业人员，在质量改进，实施， 领导变革管理。为此，VAQS协调中心的领导人已 开发了一种称为“领先的医疗保健改善（LHI）”的方法，该方法将两种经验整合在一起， 支持实施战略、循证质量改进和领导变革 管理LHI培训计划已经过VAQS研究员的测试，并准备进行调整， 为前线临床医生及手术人员提供精简的资料，以协助推行临床最佳常规。 在QUERI资助的启动期间，我们将继续促进与QUERI的关系 领导力和卓越传播计划，以培训一线供应商，特别是金牌会员 和执行设施研究员。我们将最终确定为前线人员改编的LHI计划材料 通过纳入最终用户评估的反馈，对供应商和业务人员进行培训。通过拟议的 计划，“领先的医疗保健改善：应用改进策略的领导力培训”，我们将 调整和浓缩VAQS LHI课程的实践知识和技能部分，以培训 一线医疗服务提供者实施临床最佳实践。我们将实现培训前线的计划目标 提供者通过以下具体目标有效地领导临床最佳实践的实施： 目标1：完成VAQS领先医疗保健改善计划的调整，使其成为一个互动的网络 为一线临床提供者和操作人员提供支持材料的培训计划。 目标2：培训金级研究员和执行机构研究员及其相关人员 团队，使用集成的LHI实施策略进行临床最佳实践项目。 目标3：通过以下方式评估领先医疗保健改善计划的质量和有效性： 参与者和系统级指标。 将通过使用LHI模板确保项目与LHI实施策略的一致性 以及忠诚度的标准其他评估指标包括：学员对计划的满意度， 工具的利用率，采用培训来扩展或传播临床最佳实践的提供者的数量， 受临床最佳实践的规模或传播影响的退伍军人人数，以及 实施和推广临床最佳实践所导致的医疗保健变化的影响。

Health care systems are complex; sustaining improvements in healthcare quality requires the use of tailored implementation strategies. However, the utilization of implementation strategies without an understanding of different organizational and leadership contexts results in healthcare improvements that are variably successful due to partial implementation or limited sustainability. Diffusion of clinical best practices requires effective leaders at every level of the healthcare system, including front-line providers and operational staff. Clinicians and staff who are “active and influential citizens of the healthcare community” are able to influence healthcare change. Moreover, health professionals trained in leadership principles and facile with improvement strategies are better equipped to translate clinical best practices within a local healthcare context, effectively manage interpersonal relationships, and cultivate partnerships needed to spread and sustain improvement. Despite the necessity of and synergy for teaching implementation strategies and leadership concepts together, these methods are usually taught in isolation. We propose an innovative training program for a multifaceted implementation strategy that integrates the strength of an evidence-based improvement strategy, (Model for Improvement) and leadership skills for change management (Leading Change). The VA Quality Scholars (VAQS) program, a national training program at 11 VA medical centers throughout the United States, trains interprofessional clinician leaders, including physicians, nurses, clinical psychologists, pharmacists and other healthcare professionals, in quality improvement, implementation, and leadership for change management. To this end, the leaders of the VAQS Coordinating Center have developed a methodology called “Leading Healthcare Improvement (LHI)” that integrates two empirically supported implementation strategies, evidence-based quality improvement and leadership for change management. The LHI training program has been tested with VAQS fellows and is ready to be adapted and condensed for frontline clinicians and operational staff to facilitate implementation of clinical best practices. Building upon the QUERI-funded startup period, we will continue to foster relationships with QUERI leadership and the Diffusion of Excellence program to train frontline providers, specifically Gold Status Fellows and Implementing Facility Fellows. We will finalize the adaptation of LHI program materials for frontline providers and operational staff by incorporating feedback from end-user assessments. Through the proposed program, “Leading Healthcare Improvement: Leadership Training for Applying Improvement Strategies,” we will adapt and condense the practical knowledge and skills-based components of the VAQS LHI curricula to train frontline providers to implement clinical best practices. We will achieve the program goal of training frontline providers to effectively lead the implementation of clinical best practices through the following specific aims: Aim 1: Finalize the adaptation of the VAQS Leading Healthcare Improvement program to an interactive, web- based training program with supporting materials for frontline clinical providers and operational staff. Aim 2: Train dyadic pairs of Gold Status Fellows and Implementing Facility Fellows, and their associated teams, to conduct clinical best practice projects using the integrated LHI implementation strategy. Aim 3: Assess the quality and effectiveness of the Leading Healthcare Improvement program through participant and system level indicators. Fidelity of the projects to the LHI implementation strategy will be ensured through use of the LHI template as well as a fidelity rubric. Additional evaluation metrics include: trainee satisfaction with program, trainee utilization of tools, the number of providers who employ the training to scale or spread a clinical best practice, the number of Veterans impacted by the scale or spread of the clinical best practice, and the operational impact of the healthcare change resulting from the implementation and spread of a clinical best practice.