3111 — Building Improvement Capability Through Training and Projects
Charns MP, Holmes SK, Babich L, and VanDeusen Lukas C, COLMR and Boston University School of Public Health;
Twenty-five VAMCs and five VISNs were funded by the VA Office of Systems Redesign to develop their capability to do quality improvement. To pursue this objective, grantees pursued strategies based primarily on staff education or on conducting improvement projects. Our objectives were to identify the effectiveness of each of these strategies and to identify practices that could be implemented in other sites.
Interviews were conducted with six to twelve leaders and frontline staff at each site at six-month intervals. Interviews were coded using the organizational transformation model to assess each site's leadership, impetus for change, project success, alignment with organizational strategy and integration of staff and efforts.
One-third of the sites have made effective progress in increasing their capability to do quality improvement, but most have reached plateaus in their progress. Most sites that have approached improvement capability through staff education have not had sufficient opportunity for staff to apply their skills in actual improvement projects. Without this opportunity, staff have not retained skills that they were taught and have become discouraged about improvement work. Sites that have based their change strategy primarily on conducting projects each have mostly relied on a few improvement experts, who have reached their capacity to conduct improvement work. In addition, improvement skills are not spreading to many staff. The few sites that have not plateaued have combined projects and education, and have planned projects for staff completing educational sessions. In addition, these sites have had higher levels of the other drivers of change (leadership support, impetus for change, alignment and integration, in addition to projects) than other sites.
Neither education nor involvement with improvement projects alone is sufficient to achieve an increased capacity for quality improvement. Both education and planned involvement in improvement projects, systematically integrated together with leadership support, alignment and integration, are required.
VA has placed a high priority on improving healthcare quality. The findings of this study are giving guidance to the Office of Systems Redesign, that they are incorporating in their workshops for VISN and VAMC leadership.