TY - JOUR
T1 - Spreading the Veterans Health Administration's emergency department rapid access clinics (ED-RAC) innovation
T2 - Role of champions and local contexts
AU - Penney, Lauren S.
AU - Moreau, Jessica L.
AU - Miake-Lye, Isomi
AU - Lewis, Davis
AU - D'Amico, Adrian
AU - Lee, Kelli
AU - Scott, Brianna
AU - Kirsh, Susan
AU - Cordasco, Kristina M.
N1 - Funding Information:
The spread team consisted of the ED-RAC developers, with technical assistance from VA's Office of Strategic Integration/Veterans Engineering Resource Center and financial support from the VA Office of Veterans Access to Care. This team organized the project kickoff events and group calls and provided guidance materials and one-on-one facilitation support to participating VAMCs and designated champions. The two-day virtual kickoff introduced the ED-RAC model, provided strategies for local implementation (e.g. engaging stakeholders), fed back data from the pre-implementation questionnaire (e.g. expected challenges to implementation), and provided time for discussion among the participating sites. The spread team educated participating sites on the 9 milestones, or tasks, shown in Fig. 2 , that VAMCs needed to accomplish to achieve successful ED-RAC implementation. The evaluation team were members of VA's {redacted to preserve blinding} Quality Enhancement Research Initiative (QUERI) program. Throughout the initiative period, the evaluation team periodically fed back site progress data to the implementation support team to inform their tailored outreach and support for sites that had stalled progress.
Funding Information:
Support for this work was provided by the Department of Veterans Affairs (VA), VA Quality Enhancement Research Initiative (QUERI) , Care Coordination QUERI, project # QUE 15-276 and The Office of Veteran's Access to Care (OVAC) .
Publisher Copyright:
© 2020
PY - 2020
Y1 - 2020
N2 - Background: Champions frequently facilitate change in healthcare, but the literature lacks specificity regarding champion activities and interactions with local contexts. The Veterans' Health Administration (VA) Emergency Department (ED) Rapid Access Clinic (ED-RAC) initiative used champions to spread an innovation aimed at achieving timely specialty follow-up care for ED patients. We assessed the roles champions and local contexts played in successful ED-RAC spread in the initiative's first year. Methods: Our mixed method formative evaluation included serial questionnaires, fieldnotes from meetings, and champion interviews. We analyzed qualitative data from spread site rapid and non-rapid implementers, assessing champion and contextual factors. Results: Among 24 participating VA sites, 11 were rapid implementers (i.e., implemented ED-RAC in first year), 13 were not. Site champions at rapid sites described crossing multiple organizational units to get tasks accomplished (e.g., gaining buy-in, requesting resources); champions at non-rapid sites experienced inter-departmental communication challenges and competing demands. Champions at rapid and non-rapid sites encountered similar context-related barriers (e.g. scheduling complexities) and facilitators (e.g. enthusiastic buy-in), but differed in leadership and resource barriers. Conclusions: Identifying site champions was not enough to assure rapid innovation spread. Interdependencies between ED-RAC implementation requirements (e.g., boundary spanning, resources) and champion and contextual factors helped explain variations in progress. Implications: Tailoring spread support to champion and contextual factors may facilitate more rapid spread of innovations.
AB - Background: Champions frequently facilitate change in healthcare, but the literature lacks specificity regarding champion activities and interactions with local contexts. The Veterans' Health Administration (VA) Emergency Department (ED) Rapid Access Clinic (ED-RAC) initiative used champions to spread an innovation aimed at achieving timely specialty follow-up care for ED patients. We assessed the roles champions and local contexts played in successful ED-RAC spread in the initiative's first year. Methods: Our mixed method formative evaluation included serial questionnaires, fieldnotes from meetings, and champion interviews. We analyzed qualitative data from spread site rapid and non-rapid implementers, assessing champion and contextual factors. Results: Among 24 participating VA sites, 11 were rapid implementers (i.e., implemented ED-RAC in first year), 13 were not. Site champions at rapid sites described crossing multiple organizational units to get tasks accomplished (e.g., gaining buy-in, requesting resources); champions at non-rapid sites experienced inter-departmental communication challenges and competing demands. Champions at rapid and non-rapid sites encountered similar context-related barriers (e.g. scheduling complexities) and facilitators (e.g. enthusiastic buy-in), but differed in leadership and resource barriers. Conclusions: Identifying site champions was not enough to assure rapid innovation spread. Interdependencies between ED-RAC implementation requirements (e.g., boundary spanning, resources) and champion and contextual factors helped explain variations in progress. Implications: Tailoring spread support to champion and contextual factors may facilitate more rapid spread of innovations.
KW - Care coordination
KW - Emergency medicine
KW - Facilitation
KW - Implementation science
KW - Qualitative
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U2 - 10.1016/j.hjdsi.2020.100516
DO - 10.1016/j.hjdsi.2020.100516
M3 - Article
AN - SCOPUS:85098501814
JO - Healthcare
JF - Healthcare
SN - 2213-0764
M1 - 100516
ER -