In a rare turn, the Senate Veterans Affairs Committee recently focused on what the VA is doing right. “We are changing culture and doing so by celebrating the people who have dedicated their careers to serving veterans,” testified Carolyn Clancy, MD, deputy under secretary for health for organizational excellence. “We are breaking down cultural barriers, like competition, by creating systematic incentives to share what has worked with others in the system.”
Dr. Clancy outlined some of the successes from the VA’s newly developed Diffusion of Excellence Initiative. The goal of the initiative has been to “identify clinical and administrative best practices, disseminate these practices to other sites of care, and encourage standardization of practices that deliver positive outcomes for veterans and their families,” Dr. Clancy reported. So far the initiative has generated more than 260 ongoing innovations at 70 facilities.
According to Dr. Clancy, the Diffusion of Excellence Initiative uses an internal VA social media platform to identify promising practices that align with strategic priorities, offer efficient resource use, can be implemented in diverse care environments, and can be implemented within 6 to 12 months. The initiative also sought to identify local champions or early adopters who can begin to implement the best practice locally. Once it is proven practice, the initiative seeks to find additional locations to further test the practice in a different setting. Best practices are chosen for national standardization if they have had relative success with an initial implementation and similar outcomes when replicated elsewhere.
So far 50 best practices have been replicated and are ready for widespread dissemination. “Identifying and spreading best practices can be a major driver of consistent, high-quality health care for veterans,” Dr. Clancy told the Senate panel. “This is restoring trust in the system. It offers a model for other health systems.”
Examples of best practices include the following:
Improving Same-Day Access Using Registered Nurse (RN) Care Manager “Chair” Visits: At the Boise VAMC in Idaho, the primary care team created a process where same-day appointment requests are triaged and scribed by RN Care Managers, saving primary care providers’ time when they see patients between appointments to assess and confirm the care plan.
Access Data Dashboard to Improve Clinic Management: The data analysis team at Harry S. Truman Memorial Veterans’ Hospital (Columbia, Missouri) implemented a dashboard for clinic access metrics (no-shows, completed appointment wait times, clinic utilization, etc). These metrics are posted monthly on an accessible dashboard that can be used by staff to solve problems and make key decisions that help veterans get timely access to care.
Planning for Future Medical Decision via Group Visits: This initiative presents advance care directives and other care planning for future medical decisions in interactive and patient-centered group visits.
Increasing Access to Primary Care With Pharmacists: The William S. Middleton Memorial Veterans’ Hospital (Madison, Wisconsin) matched clinical pharmacy specialists with multiple patient aligned care teams to conduct new patient intake calls 1 week before a new patient has his or her first appointment with a provider, collecting medications, noting any formulary conversions, and orienting the patient to VA.