1041 — Identifying Organizational Dimensions Underlying the Implementation of Quality Improvement Efforts in VHA

Chou AF (University of Oklahoma), Lanto A (Sepulveda VA Center of Excellence (COE)), Canelo I (Sepulveda VA COE), Doebbeling BN (Indianapolis VA COE), Fleming BB (VA Office of Quality & Performance), Yano EM (Sepulveda VA COE)

Objectives:
Systematic implementation of quality improvement (QI) practices has been associated with better clinical outcomes. Nevertheless, implementation of these efforts cannot succeed without sufficient and appropriate organizational support and resources. Using a resource-based view, we sought to identify organizational domains and factors that may facilitate institutional planning, QI design and implementation, program evaluation, and research.

Methods:
We surveyed a national sample of chiefs of staff from 111 VA facilities through the Clinical Practice Organizational Survey Study, sponsored by VA’s Office of Quality and Performance (response rate=83%). Participants responded to questions regarding resources, organizational characteristics, practice arrangements, and QI activities. We conducted a series of factor analyses to identify domains and reliable scales measuring organizational factors of interest. Cronbach alphas were calculated for each scale.

Results:
We identified 4 distinct domains containing conceptually linked factor scales for QI efforts and implementation: (1) Facility resource sufficiency, which included allied health staff sufficiency (alpha =0.82), technical staff sufficiency (alpha=0.77), physical resource sufficiency (alpha=0.74), information technology resource sufficiency (alpha=0.89), and service capacity (alpha=0.62); (2) Barriers to implementation, which included lack of human/financial resources (alpha=0.84), insufficient staffing (alpha=0.65), and resistance to change (alpha=0.82); (3) Process management, which included profiling and monitoring of admissions (alpha=0.54) and outcomes (alpha=0.66), audit-feedback strategies for decision support (alpha=0.72), data support and analysis over time (alpha=0.69), inpatient utilization management (alpha=0.77), and guideline implementation process (alpha=0.87); and (4) Organizational climate for implementation, which included cooperative culture (alpha=0.85), implementation support (alpha=0.86), quality improvement leadership (alpha=0.86), team-based collaboration (alpha=0.81), and clinical champions (alpha=0.83).

Implications:
We identified measurable factors with good psychometric properties that may facilitate implementation and evaluation of QI activities within VA facilities. If used prospectively to inform QI implementation and system redesign activities, as well as research efforts, these scales may help target areas for investments, impact performance assessment, and strategic planning.

Impacts:
Successful implementation of QI efforts has important implications for care provision and patient health and outcomes. Factors describing QI efforts identified from this study may be useful in empiric assessment to determine their effects on performance and enhance implementation and program evaluation to drive more rapid investments in improving quality of care.