VHA S R d i VHA Systems R

e

des

ig

Overview Activates, & Connections to 

Mike Davies MD Mike Davies, MDNational Director of Systems Redes
Overview of session Overview of session

• Update on VHA Systems Redesign

– Current 

priorities 

– Potential for research partnerships

• U d t QUERI P U

p

d

a

te on QUERI

Program

– Evolving models– Collaborations with SR

• Discussion
Poll X 3 Poll X 3

• Do you actively network with some

the trenches” doing p front line impro

work in the area of your research in

• Do you have a working knowledge Do you have a working knowledge

(training and experience) in “how to 

improvement?”

• Have you been connected to (atten

Have you been connected to (atten

participate, research) a VA Collabo
VHA M

VHA M

... Honor America s Veterans by prov

“Honor America

’s Veterans by prov

exceptional healthcare that improvtheir health and well being

...

”

S Rd i i Q li I

“Unceasin

g efforts of ever

yone....to make chan

Systems

R

e

design is 

Quality Impro

gy 

will lead to better patient outcomes (health), bsystem performance (care) and better professdevelopment (learning)... development (learning)...

Batalden, Paul; Davidoff, Frank. What 

and how can it transform healthcare? 

Downloaded from qshc.bmj.com on 14 
Where Does Systems Redesig

Under Secretary for Health

Principal Deputy Under

Secretary

Under Secretary for Health

Deputy Under

Secretary for Health

Secretary

N ti l

For Operations & Management

21 N t k National Oth

Systems Redesign

Program Office

21 Networks Oth

Inpatient & Specialty Outpatient Education Systems Improvem
SR: Office Committees Comm

SR: Office, Committees, Comm

Deputy Under

Secretary for Health

For O

perations & Mana

gement

National

Systems Redesign

National

Systems Redesign

p g

Systems Redesign

Steering Committee

Systems Redesign

Program Office

Leadership/

Management

Inpatient Outpatient Administrative Sys

Impro

Education Sub-committee
SR Communities SR Communities

• VISN POC’s (21)• Facilit

y p POC’s & Im

provement Professio

• Steering Committee & Subcommittees• Leadership• Collaboratives• Learning Opportunities/Schools• Schedulers (53,000)• Systems Engineers (about 40)
Some Current Activitie

Some Current Activitie

• PACT Collaborative (150 sites) PACT Collaborative (150 sites)• Inpatient Collaboratives (20 to 45 each)

– Patient Flow Center, Bedside Care Collaborative, Transit

ofC C are, 

Cance

r

– Inpatient Informatics

• Out

patient

– Access Measures, policy, – Scheduler training

• L i O t iti Learning 

Oppor

tunities

– Improvement Advisor Academy, Flow, (Access coming s– How to run a Collaborative, how to run an Rapid Process 

Workshop

– National Meetings/Conferences
Some Current Activitie

• Ad i i t ti Ad

minis

trative

– Hiring Collaborative II– Telephone Collaborative

– C&P.... DES

• Systems Improvement

– Improvement Capability Grants, – Strong Practice database– Leading Organizational Improvement Work
Some Current Activitie

• VERC’

s

– 50 + projects @ National, Network, & Loca– No-Show reduction

– Reusable medical equipment

– https://vaww.visn4.portal.va.gov/pittsburgh

/default.aspx

• Office

– Leading Health-e-Vet Scheduling package 

selection and implementation

– Role in network evaluation & measuremen
Change Process Change Process

“Lear

Lear

• Importance of champions• Importance of alignment

– Leadership priorities– Resources

• Importance of a deliberate, informed process

– VA~TAMMCS (Vision, Analysis, Team, Aim, Map, M

Change, Sustain/Spread)

– Faculty/Coaches/Coordinators

• Right tool for right problem• Don t’ underestimate the soft stuff underestimate the soft stuff

– Communication balance of push and pull– Relationships
Chang 

e Process “Learn

Hype Cycle

G t 1995 Gartner, 1995 - f W

from W
Standardization/Sprea

• Spread is a “decision to adopt.”• Spread is driven by measurement Spread is driven by measurement• Spread is fueled by standardization 

I f ti T h l In

formation 

Tec

hnology

• Th

e sta da d at o pa ado eso 

sta

nda

r

dization pa

radox: reso

vs. resistance
Research Priorities (1 

Research Priorities (1 

• Measurement of access

– How do measurement s

y 

stem time st

relate to patient perception/expectatio

• How to build improvement capabili

How to build improvement capabili

• How to motivate change in a salari

environment

• Optimal scheduling Optimal scheduling

“rules

” for prim

for prim

specialty, diagnostic, & home care 
Research Priorities (1 V

Research Priorities (1 V

• Best hospital/network flow managemen

system?

• Optimal contingency plan for each type 

suppl

y

?

• Nurse care that leads to better outcome• Best way to do Multidisciplinary Rounds Best way to do Multidisciplinary Rounds• Shift handovers• Admission and discharge planning• Ward “schedule” or rhythm
Research Priorities (1 V

Research Priorities (1 V

• Optimal task distribution in PACT

• Protocol im

plementation & outcomes

• Primary vs. specialty care roles

• Optimal specialty care value specialty care value

• Traditional vs. service agreements, v

consults vs mini consults vs. mini

-residency vs ECH

residency, vs. ECH

(Extension for Community Care Outc

www ECHO umn edu www.ECHO.umn.edu

• Other