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Findings from an Evaluation of Partnerships within VA HSR&D's Quality Enhancement Research Initiative (QUERI)


BACKGROUND: There is growing recognition that implementation of quality improvement initiatives and evidence-based innovations in routine practice can benefit from partnerships between researchers and those working in the clinical care delivery system (defined in this paper collectively as 'operations') to foster buy-in, local fit, sustainability of new programs, and more rapid translation of research into practice. In 1998, HSR&D joined with VA operations to create the Quality Enhancement Research Initiative (QUERI) to promote researcher-operations partnership projects aimed at the rapid implementation of research findings into clinical practice. This study sought to identify tensions that can undermine such partnerships, as well as the positive behaviors that can enhance them. Investigators analyzed interviews with QUERI researchers (n=50) and operations partners (n=39) – chosen randomly within pre-identified participant groups – that were part of a comprehensive evaluation of the QUERI program conducted in 2014 that aimed to better understand the effects of this large policy experiment that began more than 15 years ago. Interviewees in operations leadership were defined as clinicians or other individuals who primarily had administrative or leadership roles within national VA program offices, regional VISNs, and/or local facilities within those VISNs.

FINDINGS:

  • Two main themes were identified: 1) tensions in research/operations partnerships, and 2) key partnership building blocks that facilitate successful research/operations partnerships.
    • Tensions in research/operations partnerships focused on two areas: differing incentives, and scientific rigor and integrity versus quick timelines.
    • Partnership building blocks included: jointly designing the partnership up front; reducing the research bureaucracy burdens; prioritizing in-person communication and long-term relationships; understanding the importance of perspective-taking (mentioned by operations only); and overcoming the need for individual recognition (mentioned by researchers only).

IMPLICATIONS:

  • Results suggest that researchers may benefit from better aligning of academic incentives with contributions to the healthcare organization and establishing formal recognition of operational impacts of research, while preserving some flexibility and independence of the research process.

LIMITATIONS:

  • A convenience sample was used in recruiting some interviewees, which may limit generalizability.
  • Investigators only analyzed spontaneous discussions of interviewees' partnering experiences. Future research should focus on systematically exploring a range of explicit questions.

AUTHOR/FUNDING INFORMATION:
This study was funded through QUERI. Drs. Bergman and Miake-Lye, and Ms. Delevan are part of HSR&D's Center for the Study of Innovation, Implementation and Policy in Los Angeles, CA.


Bergman A, Delevan D, Miake-Lye I, et al. Partnering to Improve Care: The Case of the Veterans’ Health Administration’s Quality Enhancement Research Initiative. Journal of Health Services Research & Policy. April 3, 2017; Epub ahead of print.

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HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.