The opinions expressed in this article are those of

the author and not necessarily official policy of the

Department of Veterans Affairs.

The Imperative

“If you don’t like change, you’re going to

like irrelevance even less.”

The Honorable Eric K. Shinseki,

Secretary, Department of Veterans Affairs

The national consensus for change in health

care comes from increasing awareness of

inadequate access, variable quality, high

costs, and mediocre outcomes, as well as the

realization that economic stability requires

we address these shortcomings. While VA

may have demonstrated superior performance in access, quality, and outcomes, we are

not exempt from this imperative. In areas

such as polytrauma, advanced prosthetics,

and comprehensive mental health services,

the pace of change in VA has been significant. Yet, in January 2009 testimony to the

Senate Veterans Affairs Committee, Secretary of Veterans Affairs, Eric Shinseki

emphasized the need, not simply for more

of the same, but instead for fundamental

transformation into a “21st Century Organization.” He characterizes this as:

■ Centering on Veterans as clients, not

simply users. We design, implement, and

evolve our services to meet the changing

needs of Veterans through an engaged,

inspired, and empowered workforce.

■ Focusing on results, particularly the timeliness, quality, and consistency of our services.

We set and meet objectives for improved access, high-quality care, and exceptional client

relationships, using world-class technology

and business processes, leadership, accountability, and attention to effectiveness.

■ Forward looking. We anticipate Veteran

needs and are proactive in meeting them,

through an innovative, Veteran-focused culture, effective communication, and systematic outreach and collaboration.

As Army Chief of Staff from June 1999

through June 2003, General Shinseki transformed a high fixed-cost, Cold-War legacy

into an agile, versatile, and flexible fighting

force able to respond rapidly to emerging

threats. Many parallels to health care can be

drawn from the Army’s transformation.

1

A Compelling Vision

“...the core of the matter is always about

changing the behavior of people, and behavior change happens in highly successful

situations mostly by speaking to people’s

feelings.”

John P. Kotter

2

Those that study organizations closely have

observed that change is less about data,

analysis, and strategic planning than about a

compelling truth that shapes feeling and

motivates action. We appreciate as much in

clinical practice—the smoker won’t quit by

being presented statistics, but only after seeing the benefit that quitting produces.

Within VA, the vision for change takes the

F

Translatin

O

g research in

R

to quality

U

health care

M

for Veterans

Commentary

Change in Health Care

Joseph Francis, M.D., M.P.H., Acting Chief Quality and Performance Officer,

Department of Veterans Affairs

August 2009

Contents

Director’s Letter 2

Response to Commentary 3

Research Highlight

• Sustained System Change 4

HSR&D Investigators Honored 5

Research Highlight

• Nursing Home Culture 6

Organizational Profile

• CIPRS—A New QUERI

Resource Center 7

A publication of the VA Office of Research & Development,

Health Services Research & Development Service, Center

for Information Dissemination and Education Resources, in

conjunction with AcademyHealth.
form of Veteran Centered Care. This involves

anticipating patient needs by defining the

delivery system and aligning our services

around mutually negotiated needs and goals.

The care we provide, whether local or

regionalized, in-house or purchased, will

reflect the longitudinal needs of patients

rather than the expertise of specialized

clinicians. As a result, VA will increasingly

orient care around interdisciplinary teams

that share decision-making with patients

and families. Among the key principles of

such care are:

3

■ Honoring the Veteran’s expectations of

safe, high quality, accessible care.

■ Enhancing the quality of human interactions and therapeutic alliances.

■ Soliciting and respecting the Veteran’s

values, preferences, and needs.

■ Systematizing the coordination, continuity, and integration of care.

■ Empowering the Veteran through information and education.

■ Incorporating the nutritional, cultural,

and nurturing aspects of food.

■ Providing for physical comfort and pain

management.

■ Ensuring emotional and spiritual support.

■ Encouraging the involvement of family

and friends.

■ Providing architectural layout and design

conducive to health and healing.

■ Introducing creative arts into the healing

process.

■ Supporting and sustaining an engaged

workforce.

The success of this vision will require exceptional attention to coordination of care.

In health care, coordination means connections among interdependent people who

transfer information toward the goal of advising and enabling the patient and organizing care for the purpose of optimizing the

patient’s health status. Despite many

strengths (including computerized health

records and primary care teams), coordination of care remains imperfectly realized

within VHA. Key challenges include

strengthening primary care teams, establishing new systems for information exchange

for Veterans that get part of their care in

the private sector, assigning care coordinators for high risk Veterans, and fully leveraging information technology to enhance

communication.

This vision also involves significant rethinking of access to care. Veterans deserve timely

access to quality health care which meets or

exceeds internal and community standards

and is measured by their expectations. Such

access should not depend on proximity of

fixed infrastructure such as hospitals, but

rather utilize new modes of care delivery

supported by technology.

Inquiry and Learning

“In the beginner’s mind there are many

possibilities; in the expert’s mind there

are few.”

Shunryu Suzuki

4

The weight of experience makes it harder to

change. This includes past VA transformations. Lifelong learning demands we shed

old habits and question our assumptions.

For the health services research community,

old patterns include the three to five year

duration of projects (the window for transformation will be shorter than 36 months),

the selection of “safe” hypotheses and

methods (peer review may need to be recalibrated toward risk-taking and speed), and a

predilection for analyzing the past rather

than creating the future (rapid cycle, actionoriented research is more needed than ever).

Shedding these old habits will require unprecedented speed and agility as well as the

FORUM — Translating research into quality health care for Veterans 2

Director’s Letter

Given the national focus and debate about health care reform,

it seems very timely that this issue of FORUM focuses on the

topic of change. As both Drs. Francis and Atkins note in the

opening Commentary and Response articles, VA has made

tremendous progress in organizing to improve health care for

Veterans, but many challenges remain. Specifically, how do we

best implement changes that will improve the VA health care

system now and for the future, enabling us to provide consistent, accessible, highquality, cost-efficient care for all Veterans? Health services researchers can play

an integral role in assisting the organization to meet such challenges. For example,

much has been learned about implementing cost-effective, evidence-based interventions into routine clinical practice from VA’s Quality Enhancement Research

Initiative (QUERI). In addition, there are many other health services research

efforts that already have or will add to our knowledge about achieving and sustaining health care systems change. In this issue’s Research Highlight articles,

Drs. Charns and VanDeusen Lukas describe critical drivers of systems change

and Drs. Hartmann and Berlowitz discuss challenges associated with changing

the culture of nursing home care to one that is more resident centered.

In other news, HSR&D will hold its Scientific Merit Review Board (SMRB) meeting

in August. The SMRB consists of a multidisciplinary group of VA and non-VA experts

who rigorously review VA health services research proposals covering an array of

health care issues that affect Veterans’ health and care. The August SMRB will

review 113 research project proposals (an increase of 10 percent over the August

2008 review) and 82 pilot project proposals. HSR&D looks forward to supporting innovative, Veteran-centric research projects. Keep your proposals coming!

Seth A. Eisen, M.D., M.Sc.

Director, HSR&D

VA Office of Research & Development, Health Services Research & Development Service August 2009

continued on page 8
VA Office of Research & Development, Health Services Research & Development Service August 2009

The fundamental question at the heart of

the debate over health care reform is how to

redesign a dysfunctional health care system

so that it promotes quality and value.

Watching this debate, it can be tempting to

congratulate ourselves for the many ways

that VA is ahead of the private market—

for example, in our ability to measure and

reward performance, our primary-carebased outpatient system, and our electronic

health record. But as Joe Francis reminds us

in his commentary, the challenges facing VA

are no less daunting. We need to adapt to

meet the needs and preferences of a new

generation of young Veterans while maintaining our commitment to aging Veterans

from earlier wars. To do this, VA needs to

transform itself to become a high-quality,

efficient, patient-centered system. For those

of us involved in the QUERI program,

which was designed to speed the uptake of

better practices in VA, the call for such a

transformation poses two questions. How

can QUERI help facilitate that transformation, and how might this transformation

require changes to QUERI itself?

Change Lessons from the First

Ten Years of QUERI

The first ten years of QUERI taught us

many of the lessons about change observed

by Dr. Francis. Change depends on people

and relationships; it cannot be achieved simply by disseminating data or directives; success often depends on facilitation and on

the local conditions; and it usually takes

longer and costs more than we hope.

1 Three

factors, however, create new opportunities

for change in VA and for QUERI. The first

is the new leadership under Secretary Shinseki,

since commitment of leadership is one of

the essential factors in any successful change.

2

The second is consensus on a direction for

change. The Universal Services Task Force

recommendations provide a road map of

what specific changes are needed, and many

of these involve areas studied by QUERI—

implementing new models of care, expanding telehealth and Web-based interventions,

and improving coordination across

providers. Finally, the expanding work of

the Systems Redesign initiative has created

opportunities to partner with a VA-wide

effort working at the network and facility

level to address high priority process

improvements for VA.

Systems Redesign and QUERI offer complementary approaches for how to speed

change in the health care system. In Systems

Redesign, engineering approaches such as

process mapping, making small tests of

change, applying “lean” principles to eliminate waste, and collaborative learning have

succeeded in improving access and reducing

waiting times and they are expanding to address new administrative and clinical issues.

Elements of the QUERI approach, however, are essential to tackle the complex

processes of improving care in chronic disease. The clinical and research expertise

within QUERI is needed to decide which

changes are most important. For example,

the work of the Diabetes QUERI identified

“improvements” that provide little benefit

(tight glucose control in older patients) and

those that are clinically most important (improving poorly controlled blood pressure).

Implementation science can help understand the barriers and facilitators at the

patient, clinician, practice, and system level

that go beyond simple process improvement. The QUERI program can more easily

support solutions that would be hard to develop through incremental changes and

rapid process improvement—for example,

the multi-year projects to develop the infrastructure for the TIDES depression care

management model or to design the CARTCL catheterization registry. Finally, the research expertise within QUERI has been essential for refining clinical databases so we

can tell whether our efforts are succeeding.

Key Learnings from Systems

Redesign

There are important opportunities, however, for QUERI to learn from Systems Redesign to develop interventions that are

more responsive to the needs of our stakeholders and more sustainable. Attention to

engineering principles and efficiency can

identify improvements that do not require

new resources. Second, letting stakeholders

determine their own priorities for change

produces more effective engagement than

when a “solution” appears to have been developed at a distance by researchers. Finally,

learning from best performers within the

system may help convince others that the

solutions are feasible and sustainable. Several QUERI Centers, including Stroke and

Chronic Heart Failure, have begun to

collaborate on systems redesign projects to

bring the strengths of both approaches together and to foster cross-program learning.

The four new Veterans Engineering Resource

Centers (VERCs), funded under the Systems

Redesign initiative, will provide new avenues

for collaboration between research and

operations. QUERI will focus on additional

ways to foster closer and more transparent

collaboration with all of our health system

partners, such as Office of Quality and Performance and Office of Patient Care Services.

A popular Dilbert cartoon notes, “Change

is great—you go first.” It is to the credit of

VA that so many parties are “going first,”

readily embracing the call to improve the

care we deliver and the systems in which

we work. It will be our challenge to see that

we are all pulling together toward the common vision of a Veteran-centered, forwardlooking, high-quality health care system.

References

1. Stetler CB, Mittman BS, Francis J. Overview of the VA

QUERI and QUERI theme articles: QUERI Series

Implementation Science 2008, 3:8.

2. VanDeusen Lukas C, et al. Implementation of a Clinical

Innovation: The Case of Advanced Clinic Access in the

Department of Veterans Affairs. Journal of Ambulatory

Care Management 2008. 31:94–108.

Response to Commentary

Transformation and QUERI

David Atkins, M.D., M.P.H., QUERI Director, Office of Research and Development

FORUM — Translating research into quality health care for Veterans 3
How can health care systems transform to

provide consistently safe, high-quality care

for patients as envisioned by the 2001 Institute of Medicine’s (IOM) report, Crossing the

Quality Chasm? From our research in both

VA and non-VA health care organizations,

we have identified five critical drivers of

change that distinguish organizations that

have reached sustained system change—

meaning higher levels of reliability in their

care processes and greater changes in their

systems and cultures. These five critical elements are illustrated in the Figure below.

1) Impetus to transform often came from

outside the organization in response to external pressures for change, but also came

from within the organization, often stimulated by multiple factors. In successful transformations, organizations sustained impetus

for change over time.

2) Leadership commitment to quality

and change—beginning at the top of the

organization but including all levels—

proved a critical element for organizational

transformation. Senior leaders drove change

in two ways. First, they steered change

through the organization’s structures and

processes to maintain urgency, set a consistent direction, and provided resources and

accountability to support change. Second,

to create momentum for dramatic improvement in patient care, leaders demonstrated

authentic commitment to quality, by expending significant personal capital to motivate staff, often leading by example through

personal involvement in improvement efforts.

3) Improvement initiatives that actively

engaged staff in meaningful problem

solving were central to change. Improvement initiatives contributed to transformation in at least three ways. First, initiatives

such as clinical redesign improved operations. Second, initiatives actively engaged

staff in problem solving around meaningful,

urgent problems across disciplines and hierarchical levels. Third, successful initiatives

built momentum for further improvement

and contributed to culture change.

4) Alignment from top to bottom to

achieve consistency of organizationwide goals with resource allocation and

actions ensured that improvement efforts

contributed to larger system change. Accountability was a key aspect of alignment,

ensuring that behaviors, operations, and

processes in practice supported organization-wide goals.

5) Integration to bridge traditional intraorganizational boundaries between individual components occurred at a later

stage of transformation. Integration is a

multi-faceted concept that applies to all organizational levels and is both an end state

for a high-performing system and a strategy

for transformation. Integration often began

with multidisciplinary improvement teams

that encouraged communication and probFORUM — Translating research into quality health care for Veterans 4

VA Office of Research & Development, Health Services Research & Development Service August 2009

Research Highlight

The Challenges of Achieving

Sustained System Change

Martin P. Charns, D.B.A., and Carol VanDeusen Lukas, Ed.D.,

Center for Organization, Leadership, & Management Research, VA Boston

Healthcare System

Organizational Transformation Model

Mission, vision,

strategy, priorities

Culture, values Infrastructure

Organizational

functions &

processes

Impetus to Transform

High Quality Patient Care

Integration across boundaries

Improvement initiatives

Leadership

Commitment

and Support

Al gi nm

ent fro

m to

p to

b

otto

m

Organization/System
VA Office of Research & Development, Health Services Research & Development Service August 2009

lem solving across work units. However, by

themselves, improvement teams ran up

against the limits of traditional organizational boundaries. To move beyond those

limits, organizations needed integration at

the systems or organizational level in the

form of structures and processes that involved managers with decision-making authority and responsibilities spanning the

organization. Integrating structures and

processes also facilitated the spread of improved clinical practices and values for improvement across the organization.

These elements affected transformation by

driving change in complex and dynamic

health care organizations. As illustrated inside the dotted circle in the Figure, we define the organization—or network of

organizations comprising the system—in

terms of four basic components: 1) mission, vision, and strategies that set direction

and priorities; 2) culture that reflects values

and norms; 3) operational functions and

processes that embody the work that is done

in patient care; and 4) infrastructure, such

as information technology and human resources, that support delivery of patient care.

Practice Implications

Transformation of health care systems is a

complex and difficult undertaking that is

achieved over a period of time. Each model

element offers direct practice implications

for managers seeking to change their systems to improve patient care. However, no

single element is sufficient to achieve organizational transformation. Managers should

recognize that all model elements are important, and that the challenge is to maximize the likelihood that the elements will

interact with one another in complementary

ways to maintain urgency to change and to

move the organization forward. Full transformation may be attained only when multiple improvements are spread across the

system and sustained over time.

Finally, successful transformation takes

time. Transformation most likely unfolds

over a decade or more. Although many of

the systems we studied demonstrated considerable progress, they too described transformation as a continuing journey with no

fixed endpoint. Persistence and constancy

of purpose is required for this journey.

References

1. Institute of Medicine; Committee on Quality of

Health Care in America. (2001). Crossing the Quality

Chasm: A New Health System for the 21st Century.

Washington D. C.: National Academy Press.

2. Lukas CV, et al. An Organizational Model of

Transformational Change in Health Care Systems.

Health Care Management Review, 2007; 32(4): 309-20.

FORUM — Translating research into quality health care for Veterans 5

HSR&D Investigators Honored at AcademyHealth 2009 Annual Research Meeting

VA researchers had a strong presence at AcademyHealth’s Annual Research

Meeting in June 2009. A number of VA researchers—whose submissions were

competitively reviewed—presented papers, workshops, and posters at the

meeting. In addition, several VA HSR&D researchers were honored with awards.

■ HSR&D’s Werner received Alice Hersh New Investigator Award. HSR&D

investigator Racher Werner, M.D., Ph.D., received the Alice S. Hersh New

Investigator Award, which recognizes scholars that demonstrate exceptional

promise for future contributions early in their health services research career.

Dr. Werner is a Research Career Development Awardee with the VA HSR&D

Center for Health Equity Research and Promotion and a primary care internist

at the Veterans Affairs Medical Center in Philadelphia. Dr. Werner’s research

examines quality improvement initiatives—including pay for performance and

public reporting—and how those initiatives change health care delivery, overall quality of care, and racial disparities.

■ HSR&D Investigator Trivedi received AcademyHealth Article of the Year Award. HSR&D investigator Amal Trivedi, M.D.,

M.P.H., received the 2009 Article of the Year Award for his article “Insurance Parity and the Use of Outpatient Mental Health

Care Following a Psychiatric Hospitalization,” which appeared in the Journal of the American Medical Association. The award

recognizes the best scientific work in the fields of health services research and policy, produced and published during the previous year. Dr. Trivedi also received a Best Abstract award for his study “Unintended Consequences of Increased Ambulatory

Copayments on Hospital Use in the Elderly.” Dr. Trivedi is a Research Career Development Awardee with the Center for

Systems, Outcomes and Quality in Chronic Disease & Rehabilitation at the Department of Veterans Affairs in Providence, RI.

■ HSR&D Investigator Yano awarded Best Abstract. HSR&D investigator Elizabeth Yano, Ph.D., M.S.P.H., received a Best

Abstract award for her work, “Impact of Practice Structure on the Quality of Care for Women Veterans.” The abstract examines

the first attempt to evaluate systematically the quality of care experienced by women Veterans in VA settings. Yano’s research

provides a critical evidence base for VHA’s ability to reduce gender disparities and improve outcomes and satisfaction of

women Veterans.

Dr. Seth Eisen with Article of the Year awardee,

Dr. Amal Trivedi.
Long seen as places one would avoid living

in if one had a choice, in the past decade

nursing homes (NHs) have increasingly

adopted more resident-centered care paradigms, under a rubric generally termed

“culture change.” Culture change means

that residents’ needs and preferences are of

central importance in designing the structure of care, and that facility designs, routines, management, and care should be

shaped by these needs and preferences. In

reality, culture change spans a wide spectrum of potential modifications, including

minor or major modifications to the physical environment (from decorating hallways

and baking bread to removing nursing

stations and remodeling residents’ rooms),

changes in staff roles (consistent assignment of staff to the same residents and

increased autonomy of frontline staff), and

changes in management styles (incorporating input from residents and staff into

management decision-making). These

changes should also include resident participation, for example allowing resident choice

in a variety of areas and structuring life

around resident needs and wishes.

Evidence Base

The implicit goal of culture change resonates strongly with many stakeholders, but

on a day-to-day basis, culture change necessitates a fine balance between the multiple

needs and wishes of residents and potential

impacts on safety and quality of care. The

financial implications of these changes are

also a consideration. To date, relatively little

research has been undertaken on culture

change.

1 Some preliminary studies have

shown elements of culture change to correlate favorably with resident, staff, and family

outcomes, but not in all instances. For example, it has been shown that some promising changes—such as providing a more

home-like environment and promoting freedom of movement for residents—may also

have safety implications (e.g., possibility of

increased falls).

2 In addition, while consistent assignment of staff (having the same

individual work with the same residents for

at least 80 percent of her/his shifts) is one

hallmark of culture change, some evidence

about the benefits of consistent assignment

has been equivocal.

3

The redistribution of staff and redefinition

of staff jobs that culture change entails are

the source of potential tensions too. Much

of the current literature indicates that the

majority of nursing homes are already understaffed, and specific methods of improving resident outcomes often take more time

from staff (e.g., toilet training, walking improvement programs, and turning schedules

to avoid pressure ulcers). Given these competing demands, it is unclear exactly how

these changes will impact resident outcomes. Finally, with regard to cost, in a

study of culture change in a for profit nursing home chain, the primary factor that prevented timely implementation of the more

comprehensive elements of culture change

at participating sites was expense.

4

Since 2004, the VA Office of Geriatrics and

Extended Care has spearheaded the movement to change NH care, focusing on four

key elements:

1) transforming the current NH culture to a

resident-centered approach;

2) empowering frontline team members to

help address issues related to the delivery of

customized, high quality care;

3) changing the environment to foster a

homelike experience; and

4) linking transformation of the NH culture

to quality indicators.

In 2008, the Deputy Under Secretary for

Health for Operations and Management announced a name change that transformed

“Nursing Home Care Units” into “Community

Living Centers” (CLCs) to reflect this initiative. Also as of 2008, culture change has

become a performance improvement measure. Twice yearly, all CLCs must complete a

self-assessment using the Artifacts of Culture Change Tool first developed by the

Centers for Medicare and Medicaid Services.

However, despite this emphasis from top

VA management, much remains unknown.

Research Challenges

While the changes being implemented are

designed to affect residents and staff positively, they also have many as yet unknown

implications. As noted, very little research

exists on the impact of various aspects of

culture change on resident and staff outcomes such as quality of care, safety, and

satisfaction. Care must be taken, as we

move forward, to capture impressions accurately (e.g., in the case of cognitively impaired residents) as well as in sufficient

depth (e.g., including qualitative observations of resident-staff interactions). Both

short- and long-term financial implications

have to be investigated and weighed alongside the quantitative and qualitative impacts.

It is imperative that as VA moves forward

with culture change, clinicians, researchers,

and leadership all work together in a collaborative partnership to continue to define

and improve the safety and quality of care

for Veterans living in CLCs.

References

1. Rahman AN, Schnelle JF. The Nursing Home CultureChange Movement: Recent Past, Present, and Future Directions for Research. Gerontologist. April 2008;48(2):142-8.

2. Coleman MT, et al. The Eden Alternative: Findings

After 1 Year of Implementation. J Gerontol A Biol Sci Med

Sci. Jul 2002;57(7):M422-7.

3. Burgio LD, et al. Quality of Care in the Nursing

Home: Effects of Staff Assignment and Work Shift.

Gerontologist. Jun 2004;44(3):368-77.

4. Grant LA. Culture Change in a For-profit Nursing Home

Chain: An Evaluation. New York: Commonwealth Fund;

2008.

FORUM — Translating research into quality health care for Veterans 6

VA Office of Research & Development, Health Services Research & Development Service August 2009

Research Highlight

Nursing Home Culture Change

Christine W. Hartmann, Ph.D., Dan Berlowitz, M.D., HSR&D Center for

Health Quality, Outcomes, and Economic Research, Bedford, Massachusetts
VA Office of Research & Development, Health Services Research & Development Service August 2009

VA’s HSR&D and QUERI work to facilitate

improvements in the quality, performance,

and outcomes of the VA health care delivery system by applying health services

research to significant problems and by

creating and implementing evidence and

evidence-based practices.

VA’s efforts to apply research to improve

quality were strengthened in October 2008

with the establishment of a new QUERI

resource center, the VA Center for Implementation Practice and Research Support

(CIPRS). CIPRS pursues a two-part mission, aiming to strengthen implementation

research and to strengthen implementation

and quality improvement practice within

VA. This mission is accomplished via a

portfolio of programs and services that

include consultation, technical assistance,

and education.

CIPRS is led by Brian Mittman, Ph.D., and

is based at the VA Greater Los Angeles

Healthcare System. Center co-directors are

David Aron, M.D., M.S. (Louis Stokes

Cleveland VA Medical Center), and Gary

Rosenthal, M.D. (Iowa City VA Medical

Center).

CIPRS aims to:

■ Improve VA’s implementation research

capacity and performance; and

■ Enhance quality improvement and implementation practice within the VA health

care delivery system.

CIPRS Programs and Services

The CIPRS portfolio has been shaped by a

series of needs assessment interviews and

surveys designed to gather information regarding VA policy and practice leaders’ and VA

researchers’ needs and preferences. The resulting portfolio is depicted in the accompanying

figure, and described on the CIPRS website

(www.queri.research.va.gov/ciprs).

The CIPRS Portfolio

Highlights of CIPRS programs include:

■ A monthly Implementation Practice

Cyber Seminar Series offering presentations

on state-of-the-art topics in implementation

practice, aimed at a clinical audience; and a

monthly Implementation Research

Cyber Seminar Series presenting topics of

interest to implementation researchers.

■ A telephone and web-based helpline

offering one-on-one consultation to VA

implementation researchers.

■ Seminars, workshops, conference presentations, and research “clinic” sessions

offering guidance and assistance to novice

and experienced implementation researchers.

■ A series of quality improvement, evaluation, and implementation resource toolkits

under development that will offer guidance

for VA clinical and quality improvement

leaders who wish to use implementation

and quality improvement research to

improve quality and performance.

■ An extensive web-based Implementation Research Resource Clearinghouse

(under development) featuring an overview

of the field and extensive tools and resources

for planning, conducting, and reporting implementation and quality improvement projects. Resources will include evaluation tools,

compendiums, or implementation theories

and theoretical frameworks, annotated listings

Organizational Profile

VA HSR&D Establishes New Resource

Center to Support Implementation

Research and Practice

Brian Mittman, Ph.D., Center for Implementation Practice and Research Support

FORUM — Translating research into quality health care for Veterans 7

The CIPRS Portfolio

continued on page 8

Technical Support

■ Evaluation Templates

■ Implementation Toolkits

■ Experts Database

■ Recruitment Assistance

Consultation

■ Helpline

■ Implementation Clinics

Advancing the Field

■ Theory and Method

Development

Education

■ Cyber Seminars & Courses

■ Workshops

■ Resource Clearinghouse
FORUM — Translating research into quality health care for Veterans 8

David Atkins, M.D., M.P.H.,

QUERI Director,

VA Central Office,

Washington DC

Peter L. Almenoff, M.D.,

FCCP, Assistant Deputy

Under Secretary for Health

for Quality and Safety, VA

Central Office, Washington

DC

Cynthia Caroselli, Ph.D., R.N.,

Associate Director for Patient

Services & Chief Nurse

Executive, VA New York

Harbor Health Care System,

New York, NY

Martin P. Charns, D.B.A.,

Director, VA HSR&D Center

of Excellence, Boston, MA

Seth A. Eisen, M.D., M.Sc.,

Director, HSR&D

VA Central Office,

Washington, DC

Joseph Francis, M.D., M.P.H.,

Acting Chief Quality and

Performance Officer, VA Central Office, Washington DC

Rodney A. Hayward, M.D.,

Co-Director, VA HSR&D

Center of Excellence,

Ann Arbor, MI

Alan S. Perry, M.H.A.,

FACHE, Director, VA

Central California Health

Care System, Fresno, CA

Frances Weaver, Ph.D.,

Director, VA HSR&D Center of Excellence, Hines, IL

FORUM

Geraldine McGlynn, Editor-in-Chief

Margaret Trinity, Editor

Editorial Board

willingness to roll up sleeves and learn

through our actions, successes, and failures.

This won’t be easy for a number of reasons,

yet our Veterans deserve nothing less.

References

1. Frontline documentary, “The Future of War,” October

24, 2000.

2. Kotter JP. “The Heart of Change.” Boston: Harvard

Business School Press, 2002.

3. Department of Veterans Affairs. Veterans Health Care:

Leading the Way to Excellence. Report of the Universal

Services Task Force. April 2009.

4. Suzuki S. Zen Mind, “Beginner’s Mind.” New York:

Weatherhill, 1970.

Commentary–continued from page 2

Profile–continued from page 7

of funding programs, conferences, training

resources, and more.

CIPRS also contributes to the continued

development of the field of implementation

science through “Theory and Methods

Development” projects designed to develop,

test, and refine new methods and measures,

new theoretical frameworks, and approaches

and other resources.

CIPRS contributes to improved quality and

performance in VA through direct collaboration and support for specific VA quality

improvement initiatives. For example,

CIPRS is collaborating with VA’s Office of

Quality and Performance and Systems Redesign program in developing evaluation

frameworks and tools for VA quality improvement staff. CIPRS will also evaluate

national implementation of selected clinical

programs and innovations.

Collaborations with Non-VA

Entities

CIPRS seeks to contact and collaborate

with like-minded researchers and research

groups outside VA, to identify common interests and goals, and pursue opportunities

for mutually beneficial interactions. CIPRS

collaborations with non-VA implementation

research programs will facilitate HSR&D

and QUERI researchers’ ability to follow

and learn from advances in other sectors,

and will help recruit outside collaborators in

developing the Implementation Research

Resource Clearinghouse.