QUERI Evaluation Identifies Barriers, Facilitators, Lessons Learned, and Strategies to Better Standardize Veteran Safety Practices Across VA and Community Care

BACKGROUND:
The Choice and MISSION Acts were implemented to ensure that Veterans have timely access to care through increased use of VA-purchased care in the community. VA’s “Patient Safety Events in Community Care: Reporting, Investigation, and Improvement Guidebook” was designed to standardize safety practices across VA-delivered and VA-purchased care (i.e., community care). However, little is known about whether implementation of the Guidebook has been effective in standardizing safety practices. This project identified organizational barriers and facilitators related to Guidebook implementation, identified lessons learned during implementation, and developed strategies to improve future implementation. From 2019–2022, investigators interviewed 45 VA facility staff (patient safety and quality managers and VA facility community care staff) and 10 VISN-level patient safety officers at 18 geographically diverse VA facilities across 17 VISNs to assess lessons learned by examining organizational contextual factors affecting Guidebook implementation.

FINDINGS:

• Six constructs were identified as both facilitators and barriers to Guidebook implementation: 1) planning for implementation; 2) engaging key knowledge holders; 3) available resources; 4) networks and communications; 5) culture; and 6) external policies. Two constructs were identified as only barriers: 1) cosmopolitanism and 2) executing implementation.
• Lessons learned during guidebook implementation included: 1) engage all collaborators involved in implementation; 2) ensure end-users have opportunities to provide feedback; 3) describe collaborators’ purpose and roles/responsibilities clearly at the start; 4) communicate information widely and repeatedly; and 5) identify how multiple high priorities can be synergistic.
• Strategies to improve future Guidebook implementation included: 1) develop collaborator relationships between VA facility and VA CC staff; and 2) support ongoing collaborator training and education.

IMPLICATIONS:

• Findings will help partners and VA leadership to determine next steps and future strategies to improve Guidebook implementation and sustain the Guidebook’s safety practices.
• Findings may support VA’s adoption of Learning Health System tenets.

LIMITATIONS:

• Researchers relied on self-reported information from facility- and VISN-level staff, which could be subject to social desirability (i.e., responding favorably about implementation efforts).

AUTHOR/FUNDING INFORMATION:
This study was funded by QUERI. Dr. Sullivan is with HSR’s Center of Innovation in Long-Term Services and Supports (LTSS). Drs. Shin, Shwartz, Borzecki, Rosen, and Mr. Chan are with HSR’s Center for Healthcare Organization and Implementation Research (CHOIR). Dr. Miech is with HSR’s Center for Health Information and Communication (CHIC). Dr. Rosen is also supported by an HSR Research Career Scientist Award.

Sullivan JL, Shin MH, Chan J, Shwartz M, Miech EJ, Borzecki AM, Yackel E, Yende S, Rosen AK. Quality Improvement Lessons Learned from National Implementation of the “Patient Safety Events in Community Care: Reporting, Investigation, and Improvement Guidebook.” Health Services Research. May 8, 2024. Published online.