# Presentation: 237436

## Establishing a Research-Operations-Clinical Collaborative

**Polytrauma Rehabilitation Centers’ Family Care Collaborative:  a Case Study**
- National QUERI Meeting
- December 11, 2008
- Phoenix, AZ
- Presenters:
- Carmen Hall, RN, PhD, Implementation Research Coordinator, PT/BRI QUERI
- Barbara Sigford, MD, PhD, VHA PM&R National Director
- Sharon Benedict, PhD, Rehabilitation Psychologist, RICVAMC

## Objectives

- Describe the:
- general context in which a research-operations-clinical collaborative might be useful.
- roles and responsibilities of the research, operations and clinical members.
- Explore challenges presented:
- by clinical service and context;
- to traditional research approaches.
- Describe how implementation can be supported with a research-operations-clinical collaborative.

## Background

- 2005---Polytrauma Rehabilitation Centers
- 2006
- OIG report
- Experiences of staff and families
- QI information
- Research

## Phase 1: Project Start

- Family Care Advisory Group
- 1 - 2 representative / PRC
-  PM&R leadership
-  QUERI
- Reviewed and discussed
-  Research findings
-  Good experiences/ staff and family
-  Literature
-  Interviews with experts

## Roles 

- Operations
-  Leadership
-  Legitimacy
-  Resources
- Clinical
-  Rehabilitation expertise
-  Knowledge of patient care unit and experiences
- QUERI
- Facilitation
- Resources

## Phase 2: Problem Exploration...

- Aims and objectives identified
- Decrease variation in practice
- Decrease staff stress
- Increase family satisfaction with information
- Increase staff satisfaction with resources and materials
- Increase staff efficacy working with families of polytrauma patients

## ... Problem Exploration

- Review data and information to date
- Review CARF rehabilitation guidelines
- Consult with external experts
- Possible solutions identified
- Stakeholder critique, feedback & input
- April 2007-- Web-based intervention selected
- May         --  Meeting with expert panel
- May – July ---local teams developing ideas for solution

## Phase 3: Development of			Intervention

- Web-based Family Care Map
- Structure
- Content
- Web-page
- Stakeholder feedback
- Plan for evaluation
- Adaptation
- Improvement

## Family Care Map Home Page

## Web Shot of FCM

- Steps1-6

## Slide 11

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## Slide 18

## Context

- Stress
- Constant change
- Highly scrutinized
- Able, committed team
- Support from all levels
- Interest and expectations across the organization
- Stressed families
- Not many families

## Phase 4: Solution 	Implementation and Testing

- Develop implementation plan
- National Pilot
-  Continuous evaluation
-  Local adaptation of plan

## Phase 6: 	Sustained Implementation  

- National Roll Out
- Central Office
-  Program Management
-  Ongoing evaluation
- Practice and Policy

## Phase 5: Evaluation

- Successes
- Modify & adapt for unit clinical populations
- Expand access across system of care
- Expand & adapt application for other populations

## Strengths

- Synergy
- Engagement and involvement
- Multiple levels of leadership involved & aware
- Consistency in project leadership / culture
- Empower local change leader
- Principles of a learning organization---diversity
- Standardize yet accommodate local functional variation
- Share resources --- Funding, staff, systems and materials

## Challenges...

- Time to do the work
- PRC team changes
- External pressure
- Defining role of QUERI as change facilitator
- Conflict with non-VA facilitators
- Achieving consensus
- Varied experience with QI methods and workshop format

## ... Challenges ---continued

- Team very “patient-centered”
- Teams from different sites had limited experience working together
- Limited support staff available to clinicians
- Small number of family “consumers” = small *n * and large burden
- Multiple IRBs
- Consent families
- HIPAA

## Key Success Factors... 

- High priority problem
- Trust
- Clear, timely communication
- Follow through
- Clear expectations
- Co-commitment
- Mutual respect

## ...Key Success Factors 

- Shared / mutual learning
- Change leaders leadership training
- Joint problem solving and intervention design
- Flexibility- adaptability
- Sufficient resources--- Funding, staff, time, systems
- Guided by a model for organizational change

## Four Phases of Organizational Change

**Four Phases of Organizational Change**

**2. Problem Exploration **

**3. Solution Development**

- SolutionPlan

- Successful Limited Change

**4. Solution Implementation & Testing**

- Modify / adapt ?

## Family Care Collaborative Process

- Research findings
- CARF Guidelines
- Problems identified

- Family Care Advisory Group Formed
-  Supplementary data and info
-  Good & bad  experiences
-  Literature search
-  PI / QI / CQI info

- Aims and goals
- Review data to date
- Consult with external experts
- Possible solutions

- Solution identified

- Solution development &
- Iterative Stakeholder
- 	feedback

- Adaptation &
- improvement

**Supplementary **
**analyses**

- Develop
- implementation
- plan

- National Pilot
-  Continuous evaluation
-  Local adaptation of plan as needed

**Pilot evaluation**

- Modify & adapt
-  for unit clinical populations
-  expand access across system of care
-     & to other populations

**Phase 6: **
**National**** ****Roll Out**

- Phase 1

- Phase 2

- Phase 3

- Phase 4

- Phase 5

## Phases of Family Care Change Initiative

**Phases of Family Care Change Initiative**

- Supplementary analyses

- Supplementary analyses

- Adapting or improving proposal

**2. Problem Exploration **

**3. Solution Development**

- SolutionPlan

- Successful Limited Change

- National Roll-out

**4. Solution Implementation & Testing**

- Modify / adapt ?

## Summary

- Identified urgent need based on convergence of evidence about status quo
- Undeveloped evidence base...
- Creating foundation for practice-based evidence
- Polytrauma rehab experts within our system
- Experts on FCC outside VA
- Accelerated working together in a  young system
- Partnership

## Acknowledgements

- Members of  VA Polytrauma Rehabilitation Centers’ Family Care Map  Collaborative
- Family members who shared their time to offer their input while participating in the rehabilitation of a loved one in one of the Polytrauma Rehabilitation Center
- Maureen Reilly and the Family-Centered Care Map teams of the Vermont Oxford Network project
- Phil Kibort, MD, CMO & Julie Morath, RN, MS, COO (Children's Hospitals and Clinics of Minnesota)
- Steve Bergeson, MD, Allina Hospitals and Clinics
- Carol Levine, United Hospital Fund of NY
- Sue Aumer, PhD, CCDOR---FCM web-developer

## References

- Institute for Healthcare Improvement. *The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement.*2003. Institute for Healthcare Improvement. Boston, MA.
- Implementation Framework:  Organizational Change Manager (OCM) (Gustafson & Steudel, 1998-2008)
- Ovretveit J, Bate P, Cleary P, Cretin S, Gustafson D et al. Quality collaboratives: lessons from research. Qual Saf Health care. 2002; 11;345-351.
- _[www.hsrd.minneapolis.med.va.gov/FCM](http://www.hsrd.minneapolis.med.va.gov/FCM)_