Evaluation of Improvement Capability 

Grants: 

Lessons from the Field, Part 2

Carol VanDeusen Lukas, EdD

Martin P. Charns, DBA

Center for Organization, Leadership & Management Research 

(COLMR)

February 2013 

Center for Organization, Leadership & 

Management Research 1
Q1. In the past year have you been 

involved in a team to improve work 

processes or outcomes? 

• No

• Yes, as a team member

• Yes, as a team leader

• Yes, as an improvement 

advisor/facilitator/coach

Center for Organization, Leadership & 

Management Research 2
Systems Redesign (SR) competitively 

awarded 30 grants

• RFP with broad guidelines to encourage local 

strategies to build improvement capability

• Grants awarded to VISNs & medical centers

– 10 grants in 2009 to 7 medical centers & 3 VISNs 

– 20 grants in 2010 to 18 medical centers & 2 VISNs 

• Three-year grants with total possible funding of 

$450-$500K/year

• All grants now completed

Center for Organization, Leadership & 

Management Research 3
Participating Grant Recipients

2009

• Alaska HCS 

(Anchorage)

• Cincinnati

• Erie

• Fargo 

• Indianapolis 

• Muskogee

• Tampa

• VISN 6

• VISN 7

• VISN 12 

2010

• Ann Arbor

• Bay Pines

• Chillicothe

• Cleveland

• Columbia SC

• Connecticut HCS

• Detroit

• Durham

• Greater Los Angeles 

HCS

• Lexington

• Madison

• Southeast Louisiana 

HCS (New Orleans)

• Nebraska-Western 

Iowa HCS (NWI)

• Orlando

• Palo Alto HCS

• Providence

• Tomah

• Washington DC

• VISN 17

• VISN 22

Center for Organization, Leadership & Management Research 4
COLMR evaluation approach

• COLMR two-person teams conducted site 

visits with the 30 grantees at 6 month 

intervals

• Grantees included VISNs & individual facilities 

• Currently conducting

• One-year follow-up visits with 2009 sites

• End of grant visits with 2010 sites

Center for Organization, Leadership & 

Management Research 5
Majority of sites showed good 

progress 

• 74% fully or mostly met their grant objectives

• 65% fully or mostly spread grant activities 

beyond the original pilot area or clinical focus

• 68% fully or mostly planned to sustain grant 

activities after grant funding ends

Center for Organization, Leadership & 

Management Research 6
An improvement culture consists of:

• Engaged staff with improvement skills

• Infrastructure of expert skills, structures & 

culture to support improvement

• Senior leaders engaged in system 

improvement

Center for Organization, Leadership & 

Management Research 7
Q2. How would you describe the 

improvement culture in your 

organization?

• Improvement work throughout the 

organization

• Scattered pockets of improvement work

• Minimal improvement activities

Center for Organization, Leadership & 

Management Research 8
Key factors in developing 

improvement capability that builds a 

culture of improvement

– Improvement training linked with application to 

improvement projects

– Data & skills to analyze

– Strong improvement infrastructure 

• Front-line staff engagement

• Middle manager engagement 

• Senior leadership engagement

• Strategic alignment with organizational priorities

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Management Research 9
• Impetus to transform, 

• Leadership commitment to 

quality, 

• Improvement initiatives

that actively engage staff 

in meaningful problem 

solving, 

• Alignment to achieve 

consistency of 

organizational goals with 

resource allocation & 

actions at all levels of the 

organization, & 

• Integration to bridge 

traditional intraorganizational boundaries 

among individual 

components.

VanDeusen Lukas, Carol, Holmes, Sally K., Cohen, Alan B., Restuccia, 

Joseph, Cramer, Irene E., Shwartz, Michael, Charns, Martin P. (2007). 

Transformational change in health care systems: An organizational model. 

Health Care Manage Rev, 32(4), 309-320.

Conceptual Framework for Improvement Capability Grants

Center for Organization, Leadership & 

Management Research 10
Front-line engagement

• Important because front-line staff

– Provide direct perspectives on what needs 

improvement

– Will be involved in implementing the improved 

practices

• Involving them in improvement activities

– Gets better solutions & results

– Gains staff buy-in needed for sustained change

– Provides skills and motivation for further 

improvement

Center for Organization, Leadership & 

Management Research 11
Front-line engagement

• Challenges

– Lack of knowledge of systematic improvement methods

– Training without opportunity to apply

– Day-to-day responsibilities make it difficult for staff to 

participate on improvement teams 

• Engagement beyond training is facilitated when

– Time for improvement teams & committee work is built into 

scheduling for front-line staff

– Involvement in improvement activities is part of performance 

goals

Center for Organization, Leadership & 

Management Research 12
Middle manager engagement 

Middle managers play critical roles in the 

organization

Challenges

 Lack of understanding of & skills in improvement 

methods

 Pressures of staff time for regular duties

 Skepticism about new methods

Desire for training targeted to middle managers

Center for Organization, Leadership & 

Management Research 13
Middle manager engagement

• Ways to increase middle management 

engagement in improvement

– Target for training 

– Provide coaching & support in conducting projects 

– Involve in management guidance teams to convene & 

oversee projects

– Hold accountable for improvement in performance 

plans

– Create a culture where leading an improvement team 

or serving on a management guidance team is a sign 

of status

Center for Organization, Leadership & 

Management Research 14
Senior leadership engagement

• Engaged leaders:

– Develop & communicate a vision for continuous 

improvement aligned with strategic priorities

– Are knowledgeable about & model improvement 

principles & behavior

– Understand requirements for improvement 

success & develop systems to support that success

– Foster active collaboration in improvement by 

establishing a psychologically-safe environment

– Are knowledgeable about PI projects, training & 

other activities 

Center for Organization, Leadership & 

Management Research 15
Senior leadership engagement

• Challenges

– Changes in leadership typically slow progress &/or change 

priorities 

– Lack of shared vision among Quadrad members about the role 

of improvement

– Lack of constancy of purpose 

• Strategies for meeting challenges

– Build on Leading Organizational Improvement Workshops 

(LOIWs)

– Mount communication campaigns using successful examples in 

redesign 

– Create systems redesign peer mentors for Quadrad members

Center for Organization, Leadership & 

Management Research 16
Q3. How engaged is senior management team 

(quadrad) in improvement work in your organization?

• All members are knowledgeable & regularly 

supportive 

• Some but not all members are knowledgeable 

& supportive

• There is little consistent engagement & 

support by the quadrad

Center for Organization, Leadership & 

Management Research 17
Improvement aligned with 

organizational priorities

• History of improvement projects being done 

in isolation

– Teams don’t have support if they run into 

problems or need to cross organizational 

boundaries

– Projects don’t have resources because not high 

priority

– Project success does not last or spread

Center for Organization, Leadership & 

Management Research 18
Improvement aligned with 

organizational priorities

Strategies

 Select projects to support clinical & business 

strategic directions

 Implement use of processes & tools for project 

selection

 Ensure accountability & allocate resources to 

improvement projects

Develop systems for monitoring & sustaining 

improvement results

Infrastructure designed to support alignment

Center for Organization, Leadership & 

Management Research 19
Complementary SR & other initiatives

• Leading organizational improvement workshops 

(LOIWs) -- completed in FY12

• Veterans Engineering Resource Centers (VERCs)

– Direct support to national, VISN & local redesign efforts 

– Training in lean methods at different levels 

– Targeted middle manager training

– Lean deployment pilot

• Improvement culture guidebook

– Field-based analytics workshop

For more information, contact Ro Hurley at ro.hurley@va.gov

Center for Organization, Leadership & 

Management Research 20
Developing improvement capability to 

build culture of improvement

• Improvement training linked with application to 

improvement projects

• Data & skills to analyze

• Strong improvement infrastructure 

• Front-line staff engagement

• Middle manager engagement 

• Senior leadership engagement

• Strategic alignment with organizational priorities

Center for Organization, Leadership & 

Management Research 21
Contact information

• At COLMR:

– Carol VanDeusen Lukas at 

carol.vandeusenlukas@va.gov

– Martin Charns at martin.charns@va.gov

– Lauren Babich at lauren.babich@va.gov

• At SR:

– Ro Hurley at ro.hurley@va.gov

Center for Organization, Leadership & 

Management Research 22
OTM references

• OTM model available at: otm.bu.edu

• Lukas CV, Holmes SK, Cohen AB, Restuccia J, Cramer IE, 

Shwartz M, Charns MP. An organizational model of 

transformational change in healthcare systems. Health 

Care Management Review, 2007; 32(4): 309-320

• Lukas CV, Engle RL, Holmes SK, Parker VA, Nealon 

Seibert M, Petzel RA, Shwartz M, Sullivan JL. 

Strengthening organizations to implement evidencebased clinical practices. Healthcare Management 

Review, 2010, 35(3), 325-245

Center for Organization, Leadership & 

Management Research 23