As VA moves towards a true spirit of innovation through the MyVA initiative, leadership and staff across the country are pitching in their time, creativity, passion, and a true understanding of Veterans’ needs to help improve the VA experience. These “innovations” address the Under Secretary for Health, Dr. David Shulkin’s top priorities including:
- Employee Engagement
- Care Coordination
- Best Practices
- Veterans’ Trust in VA Care
To help spread the word or diffuse these innovations, VA is embarking on a threefold Diffusion Process:
- Established the Promising Practices Consortium and Diffusion Council. VHA stood up a community to promote promising practice sharing between facilities and the diffusion of best practices, including a Diffusion Council governance process..
- Facilitating the Diffusion of Gold Status Best Practices: The finalists were further narrowed to 13 Gold Status Best Practices, which will be replicated in VA health care facilities across the system.
- Establishing a Sustainment Strategy: VA will establish a mechanism for incentivizing and institutionalizing the identification and diffusion of practices nationwide so that every facility has the opportunity to implement the solutions that are most relevant to them.
More than 250 ideas were narrowed to a field of 13 Gold Status Best Practices as follows:
- Improving Same Day Access Using RN Care Manager “Chair” Visits – Clerical associates help pre-screen patients who need to be seen same-day, without a prior appointment.
- Access Data Dashboard to Improve Clinic Management – Clinic access metrics (no shows, completed appointment wait times, clinic utilization, etc.) are posted monthly on an accessible dashboard that can be used for problem solving and decision support.
- The Journey to Open Access in Primary Care Achievement and Sustainment – Using systems redesign principles and VA’s Patient Aligned Care Team (philosophy, focuses on implementing new protocols that can increase the access rate of patients being seen for same-day appointments.
- Increasing Access to Primary Care with Pharmacists – Clinical Pharmacists play a larger role in the Care Team, helping Primary Care Providers support patients and increase Veterans’ access to care.
- Audiology and Optometry Direct Scheduling – The new direct scheduling processes eliminate redundant consultations, consolidate clinic profiles, and standardize communications – leading to greatly reduced overall wait times for Audiology and Optometry.
- eScreening Program – eScreening is a mobile technology that can significantly improve care coordination and business processes via Veteran-directed screening, real-time scoring, individualized patient feedback, instantaneous documentation of clinical information to the VA electronic medical records system, immediate alert to clinicians for evaluation and triage, and monitoring of treatment outcomes.
- Regional Liver Cancer Tumor Board – Combining a regional telehealth-supported Liver Cancer Tumor Board, a web-based submission process, and a consolidated database to manage/track communications has resulted in shortened time to evaluation and first treatment as well as reducing unnecessary biopsies.
- Unit Tracking Board: where we stand at a glance – Provides a solution to the often chaotic problem of distributing data to the nursing staff. The unit tracking board is an easy-to-read, low-cost, customizable tool to present unit data and drive performance improvement.
- Using External (Non-VA) Comparative Data to Achieve Excellence and Engage Employees – To do a better job of comparing our outcomes, not only against the VHA average, but also against “the best”, expands on non-VA benchmark data to provide indicators of how Veteran/Caregiver stakeholders view the VA care in relation to other health care choices in the region – resulting in higher performance and employee engagement.
Quality and Safety
- Planning for Future Medical Decision via Group Visits – An interactive and patient-centered process used to engage Veterans in planning for future medical decisions, allowing for patients’ wishes to be honored while reducing unnecessary treatments.
- WAKE Score for Recovery from Anesthesia / Sedation – WAKE score replaces a previous anesthesia system which would often leave patients with nausea/vomiting, lightheadedness, and pain taking on a “zero tolerance” approach to anesthesia side effects.
- Flu Self-Reporting Desktop Icon to Capture Employee Vaccinations Received Outside the VA – With a click of a workstation icon, employees can report flu shots they received outside the VA. The icon has captured an average of 500 vaccinations annually.
- Code Tray Redesign – A simple and compelling solution designed to improve the time it takes to find a certain drug during a code. An easy-to-implement, low-cost strategy to reduce medication distribution errors.
We look forward to continued energy, support, and leadership to help achieve the vision of the Under Secretary and myVA. We will modernize VA’s culture, processes, and capabilities in order to put the needs, expectations, and interests of Veterans first.
About the authors: Shereef Elnahal, M.D., (pictured) is a White House Fellow appointed to the Office of the Under Secretary for Health; Patrick Littlefield, Ph.D., is the executive director of VA’s Center for Innovation and Andrea Ippolito is the leader of the VA Innovators Network.