RRP 12-535 – HSR&D Study
Career Development Projects
Telegenomics in the VHA: Evaluation of the Implementation Process
Barbara N Lerner PhD MS BA
VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA
June 2014 -
Genomic s Medicine Service (GMS) is tasked with implementing a national telehealth program, Telegenomics, to give Veterans access to high quality genomics services across the VA. Prior to our study the program had been implemented in about 40 sites with varying degrees of success. It was unclear why some sites had more difficulty implementing the program than others.
Our objective was to do an evaluation of the Telegenomics implementation process. Study findings would be used to better understand the barriers and facilitators of the implementation process so that it can be improved for use in implementing Telegenomics at future VA facilities.
To achieve our objective we conducted a mixed-methods study. We interviewed individuals involved in the implementation process and analyzed the data qualitatively to identify facilitators and challenges to the process. We also collected quantitative data related to organizational culture, and used data from the All Employee Survey to measure organizational climate at each of our sites to assess organizational differences between sites. Finally from administrative data sets we measured other organizational characteristics of each site that may affect implementation (e.g. facility size).
The design and methodology were based on: (1) relevant domains and constructs (22) from the CIFR conceptual framework, and (2) the Feedback and Programming Theory of Coordination.
We conducted the study in two phases. In Phase 1 we did an interpretive-based formative evaluation of 5 facilities, 3 facilities in which Telegenomics was efficiently implemented and 2 facilities in which significant obstacles to implementation were encountered that impacted efficient implementation. Using semi-structured interview guides, we collected data from up to 8 individuals at each site who were involved in the implementation process. In addition, we will interview providers at each facility to assess their satisfaction with the Telegenomics program, and GMS staff who were involved in assisting facilities to implement the Telegenomics program.
We analyzed interview data qualitatively to identify concepts and themes related to the implementation process. We also analyzed quantitative data measures regarding organizational culture and climate, and organizational characteristics from administrative data sets. In Phase 2 we provided feedback to our GMS partner based on our findings in Phase 1 and worked with developed recommendations to make the implementation process more efficient.
We interviewed 42 individuals at our 5 sites, and 7 individuals at GMS and other individuals closely involved in the national VA telehealth effort. Our analysis showed that the CFIR constructs that distinguished between facilities with low and high implementation efficiency were: Networks and Communication; Planning; Readiness for Implementation; and Executing. In particular high efficiency sites benefited from having facility coordinators who thoroughly understood the implementation process and had strong inter-departmental relationships that facilitated communication and timely task completion.
Recommendations include: getting buy-in from leadership and stakeholders prior to beginning the process; engaging all stakeholders early in the process; mapping out the process so that all involved are included, and understand their role and overall goals; and developing and nurturing inter-departmental relationships to facilitate communication and teamwork.
Organizational characteristics, including culture and climate, did not discriminate between low and high efficiency facilities.
By better understanding the barriers and facilitators of the Telegenomics implementation process we can improve it for use in implementing the program at future sites. The implementation of Telegenomics at other sites will increase the quality and access to genomic services for Veteran throughout VA.
None at this time.