# Presentation: 301148

## QUERI National Meeting – Closing Session

- David Atkins
- QUERI Director
- December 11,2008

## Closing Comments

- Reflections on the meeting
- Building blocks to a new QUERI vision

## Selected Lessons from the Meeting

- Value of self-reflection
- Value of qualitative methods
- Managing complexity
- Transactional management
- Opportunities arising from crisis
- Learning from other fields
- Engaging stakeholders on priorities
- Measuring implementation success
- Engineering principles to improve implementation

## Fundamental Questions 

- Who are our customers?
- What are our strengths?
- What are the challenges?
- What do we want to accomplish?

## Customers and Partners– Current or Potential

- VA clinical leadership
- Patient Care Services
- OEHPH, ONS, OI
- Quality and Safety
- Other researchers
- Network leadership/ Operations (10N)?
- Facility leadership ?

## What Are Our Strengths(what can we do better than anyone)

- Clinical expertise
- Really understanding the data

## Understanding Data

**Understanding Data**

**Notes:**
The first obligation of research is to make sense of the plethora of data available on  VHA care – to determine which data is good enough for decision making, and based on that, what issues are most important.  I had never realized Dilbert was actually a VA employee until  I came across this cartoon. Dilbert has at least been keeping up with his cyber-security training. 

## What Are Our Strengths(what can we do better than anyone)

- Clinical expertise
- Really understanding the data
- Focus on what is most important
- Over long term

## Knowing What’s Important 

## What Are Our Strengths?(what we do better than anyone)

- Understand clinical nuance and context
- Really understand the data
- Commitment to what is most important
- Mix qualitative and quantitative methods
- Independence

## It is difficult to get a man to understand something if his salary depends on his not understanding it. 	Upton Sinclair

- The Importance on Independence

## What Are Our Strengths?(what we do better than anyone)

- Understand clinical nuance and context
- Really understand the data
- Commitment to what is most important
- Mix qualitative and quantitative methods
- Independence
- Comprehensive view of outcomes (including unintended consequences and costs)

## What Are the Challenges?

- Who owns QI in the VA?
- Are we building what they are buying?
- How do we relate to other efforts with similar goals such as system redesign?
- End of flush funding environment
- Changing leadership
- Competing for attention absent a crisis

## What Do We Want To Accomplish? Smaller and Safer 

- Steady, marginal improvements in discrete but important clinical areas
- Doable
- Can make useful contribution
- May be partly generalizable outside VA
- Customer demand may vary

## What Do We Want To Accomplish? Bigger and Bolder

- Contribute to transformational change in the culture of quality in the VA
- Re-establish VA’s leadership in quality
- Imbedding evidence-based implementation
- Creating a library of tools and solutions
- Promoting population based quality management
- Optimizing the potential of new technology
- Building value