Article Highlights VA's Online Quality Improvement Toolkits
Each VA healthcare facility receives reports comparing its performance with other VA facilities on high-priority conditions, and then must formulate quality improvement (QI) plans to address sub-optimal performance. While individual sites invest local resources to develop solutions to their specific performance challenges, these solutions may be helpful at other sites as well. In 2009, VA/HSR&D's Quality Enhancement Research Initiative (QUERI) was tasked by VHA leadership to develop online toolkits that would facilitate the spread of locally developed innovations to improve quality of care for Veterans. The QI Toolkit Series was designed as a two-year pilot project that would offer VHA staff access to innovations to help improve performance on specific performance measures across a variety of high-priority care conditions. The Toolkit Series is now an enhanced Intranet website, accessible by all staff using the VHA network. This article describes the general approach to creating such toolkits, aspects of implementation, and a brief evaluation.
There are five basic steps in the development of each toolkit: 1) Determine metrics (e.g., identify quality indicators and performance measures specific to a clinical condition or process); 2) Find, collect, and catalog existing innovations (e.g., identify tools that fit metrics); 3) Vet potential tools (e.g., evaluate utility of potential tools); 4) Package and post toolkit to the website (e.g., make toolkit effective, accessible, interactive, and attractive); and 5) Conduct marketing and dissemination (e.g., publicize and promote website, motivate use and tool adoption). From the first toolkit's launch (Lung Cancer Care Toolkit) in November 2010 through September 2013, more than 16,400 users from all 21 VISNs have accessed at least one toolkit. Evaluation of the toolkits suggests that they are valued innovations, particularly among users most likely to benefit from them, such as healthcare providers who are responsible for improving performance metrics. Evaluation results also identified three key predictors for tool adoption: 1) awareness of local performance on quality indicators; 2) organizational readiness for change, including leadership support; and 3) participation in a QI collaborative. Future evaluation will investigate links between tool adoption and changes in facility performance. In addition, the article notes that the VHA QI Toolkit Series construction, dissemination, and evaluation processes also may be useful for non-VA stakeholders.
This work was supported through QUERI. Dr. York is part of HSR&D's Center for the Study of Healthcare Innovation, Implementation and Policy in Los Angeles, CA.
York L, Bruce B, Luck J, et al. Online Toolkits for Metric-Driven Quality Improvement: The Veterans Health Administration Managed Grassroots Approach. The Joint Commission Journal on Quality and Patient Safety “Tool Tutorial” December 2013;39(12):561-567.