Evaluation of a National VA Organizational Structure Redesign

理由：我们的业务伙伴，卫生局助理副局长办公室 对于临床手术(10NC)，要求QUERI合作评估重新设计的国家 临床服务组织结构，称为综合临床社区(ICC)。 解决差距：在这项提议之前，QUERI启动资金用于与 VHACO和VISN领导人，以便阐明国际刑事法院重组背后的逻辑模式，以及 确定可用于评估VAMC的ICC实施情况的有效调查指标 和VISN级别的分析。然而，我们的采访显示，VAMC级别的逻辑模型并不是 以及VISN级和VHACO级逻辑模型。这在一定程度上是由于决定 不要求在VAMC分析层面根据从 20世纪90年代服务线重组。因此，VAMC级别可能会有很大范围 ICCS的实施。在VHACO的分析层面上，ICC的实施可能是 受到国际刑事法院领导和现有VHACO之间角色和责任重叠的威胁 项目办公室。 创新：改善VHA政策制定和实施的机会出现了 很少见。上一次大规模的组织重组是VISN进行了20年的重组 几年前。我们的团队包括一名前VISN重组的评估员。拟议的评估 将提供所需的及时反馈，以指导10NC如何确保这项工作得到改进 关爱退伍军人。 具体目标：拟议的为期18个月的方案评估有两个具体目标：(1)实地、评估 并详细说明ICC调查，以及(2)确定VHACO ICC实施如何实现 对逻辑模型的期望。 项目方法：拟议的评估将使用观察法。一项量化调查 与QUERI启动基金一起制定将衡量六个ICC中每一个的中期成果 在设施层面和VISN层面。目标1将使用定性访谈来更好地理解逻辑 VAMC级别实施的模型。目标2将使用定性访谈来评估国际刑事法院 VHACO级的实现达到了ICC逻辑模型的预期。

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.