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2019 HSR&D/QUERI National Conference Abstract

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4076 — Setting the Table for Active Engagement for Implementation among New QI Teams within the Veterans Health Administration (VHA)

Lead/Presenter: Teresa Damush,  COIN - Indianapolis
All Authors: Damush TM (Precision Monitoring for Quality QUERI Center/Center for Health and Information Communications, Indianapolis), Miech EJ, Precision Monitoring for Quality (PRIS-M), QUERI Center/Center for Health and Information Communications (CHIC), Indianapolis; Rattray NA, Precision Monitoring for Quality (PRIS-M) QUERI Center/Center for Health and Information Communications (CHIC), Indianapolis; Homoya B, Precision Monitoring for Quality (PRIS-M) QUERI Center, Indianapolis; Myers L, Precision Monitoring for Quality (PRIS-M) QUERI Center/Center for Health and Information Communications (CHIC), Indianapolis; Cheatham A, Precision Monitoring for Quality (PRIS-M) QUERI Center, Indianapolis; Martin H, Precision Monitoring for Quality (PRIS-M) QUERI Center, Indianapolis; Williams LW, Precision Monitoring for Quality (PRIS-M) QUERI Center/Center for Health and Information Communications (CHIC), Indianapolis; Bravata DM, Precision Monitoring for Quality (PRIS-M) QUERI Center/Center for Health and Information Communications (CHIC), Indianapolis

Objectives:
A paucity of evidence exists regarding successful strategies that may be used to systematically among clinical teams to proceed from pre-implementation to active implementation. We sought to identify successful engagement of clinical front line staff to begin active implementation for process change within the local context.

Methods:
We compared and contrasted the levels of engagement utilized by program facilitators across 4 QI programs within the (VHA). The 4 QI programs encompassed 21 VHA medical centers and 168 clinical staff. Levels of engagement at the start of active implementation included: 1. Leadership engagement; 2. Medical Center Checklist completion; 3. Onsite demonstration of clinical innovation; and 4. A devoted onsite engagement meeting with local team and leadership supplemented with videoconferencing by the facilitating team, team goal setting and action planning. We employed mixed methods to evaluate including: % local team participation in active implementation; % local team developed and completed goals; and semi-structured interview data based upon the Consolidated Framework for Implementation Research (CFIR) to evaluate the inner settings, local medical centers within a healthcare system.

Results:
After beginning active implementation, Programs 1 and 2 had to invest more time into front line engagement due to low % participation. Program 3 had to modify its implementation model to centralize the delivery of the planned innovation given the limitations in % of local team participation. Program 4 achieved the greatest participation in active implementation where each of its teams created an action plan. Local teams from Project 4 attributed their implementation success to an all-day onsite facilitated engagement meeting which included description of the practice gap, audit and feedback, barriers identification, planning and goal setting; facilitation and team dynamics. CFIR inner setting domain concepts of networks and communications and tension for change were key for activation.

Implications:
It is critical to engage the local front line teams sufficiently beyond a single point of contact. One successful engagement strategy includes immersing front-line clinical staff and leadership representing key clinical services in a planning retreat to activate the team, and locally design an action implementation plan to move forward.

Impacts:
Planning retreats may be applied towards process changes involving multiple services and stakeholders.