VA Diffusion – spreading and implementing best practices to improve care for our nation’s Veterans


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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:

  • Access
  • 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:

  1. 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..
  2. 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.
  3. 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:

Access

  • 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.

Care Coordination

  • 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.

Employee Engagement

  • 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.


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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.

 

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— VAntage Point Contributors provide insight and perspective on a wide range of Veterans issues. If you’d like to contribute a story to VAntage Point, learn how you can submit a guest blog at http://www.blogs.va.gov/VAntage/how-to-submit-a-guest-post/

Comments

  1. Francesco Ruggiero    

    I am in search of information about a Diabetic Alert Service Dog. I am a 100% disabled Vietnam Combat Veteran, 1968-69, & a victim of exposure to Agent Orange. I have diabetes and its related illnesses because of this exposure. Can anyone help me about a Diabetic Alert Service Dog, or a VA program of anything related to this ??

  2. Francesco Ruggiero    

    I am in search of help concerning Diabetic Alert Service Dogs. I am a 100% disabled Vietnam Combat Veteran with Diabetes and related illnesses from exposure to Agent Orange while in Vietnam 1968-69. I need information and help. Will some one please respond to my call for HELP??

    1. Julia Perry Briggs    

      Don’t ask your local VA people anymore. Call the crisis line whenever you feel you’re falling apart, where that would be alleviated if you had properly adapted Service Dog (establishes track record of documentation)
      Start checking with powerful people inside the State level of each of the national Vet’s organizations (but watch out, plenty of them throw pre OEF/OIF stuff in circular file, they forget about longer term needs.
      Buddy up, Francesco, with a few VERY FIRM friends who will assist you in pushing this in social media and PHONE CALLS. I have confidence the right pooch is out there for you. Blessings, Julia Perry Briggs, Huntsville, AL

  3. EUGENE W TANNENBAUM    

    request for IG contact never consummated for years. ????why????

    1. Julia Perry Briggs    

      IG toyed with my complaints in 1994, said I hadn’t behaved like a typical victim after the fact (you KNOW they had no data back then about how a patient might feel to be therapeutically deceived, stalked across state lines, exploited and raped 3 times). Also, they ignored proof from Tx State Bd of Medical Examiners, who suspended [the doctor’s] license for 5 yrs w/stay of suspension & all kinds of rigid treatment and monitoring to see if he could become less impaired. He was even retired full bird USAF, MD PhD, and Clinical Faculty! I got stuck under his care for pain management of injury that ended my VA career. VA let him retire with flying colors, he went across town and at Texas State Hospital, got caught drugging and molesting another patient, license ended up getting revoked for life, but you know VA dragging it’s heels allowed other veterans to be vulnerable to the predator. He is 88 now, a neighborhood hero (he lives in area where fellow middle school students resided & was within the area for the Methodist Church where my Dad was pastor). IG expressed no interest in measuring whether I’d been damaged and if I needed help, they were predisposed to make me feel guilty for violating their “sense of fairness to the physician,” despite the two Texas cases I provided them–all a matter of public record. 1151 case against them for PTSD benefits caused by VA medical care prevailed “in principle”, but effective date is 22 yrs after I filed claim and 30 yrs after I notified Hospital Chief of Staff what he was doing. I’ve sabotaged my life over and over since then, didn’t realize til last autumn that the rapes were a drop in the bucket, it was the exploitation, therapeutic deception and stalking across state lines after I tried to get away, including tricking little brother into giving up my phone number, lying to VAMC he had a Medical Conference and FLYING OUT TO SHOW UP ON DOORSTEP OF MY HUD EFFICIENCY APARTMENT, TRIED GIVING ME A GIFT THAT I MARCHED RIGHT TO DUMPSTER WITHOUT OPENING, INTERFERED FREQUENTLY WITH VA PROVIDERS IN MY NEW CLINIC, which means he illegally kept a copy of my Med Record, but I wasn’t his or the hospital’s patient anymore. HE CALLED ME AGAIN ONE MORNING DURING FINALS WEEK (I was pursuing MBA at a Top 50 school), I walked into Accounting Final, signed my name and walked out. That starts decades of self-sabotage, but VA doesn’t agree I had Category A, the traumatic event, and no matter what, they wouldn’t give me a C&P exam and work on my claim for 22 years. The IG cannot ever be the friend of a patient who’s gone through a VA tragedy. Wish I could help you, Eugene! Eugene, I’d like to know if I might help you, and I hope you are ok. Here’s the takeaway for you from my rant

      Editor’s note: Portions of this comment have been redacted per VA’s social media policy.

  4. Alverna Howlett    

    Our Veterans should be able to change their PCM without approval from anyone… My husband has tried 3 times to change his and every time told no… His PCM is trying to kill him and refuses pain meds that work (opidis) or even let him see pain management for chronic pain.

    1. Julia Perry Briggs    

      I sincerely believe you. Other vets issues you need to know about #doctoredabuse I have gotten a State med. license of an impaired VA doctor punished, but it took him getting caught at a subsequent hospital for the license to be revoked for life. Documentation of all of this to the VA just hasn’t helped my situation at all. 22 year wait after filing PTSD claim before they’d give me a C&P, blatantly lied about effective date to retaliate against me, turn me down for parts of Sexual Trauma programs because my assaults were after I got out of uniform. And refuse to let me have trauma treatment in private sector at VA expense, when it was VA doctor who did me in, to begin with.
      Bless your hearts, I wish I could help. And, thank you for examining what I’ve provided. Something is so wrong with society that they don’t make uproars. Nine male vets molested/sodomized at Leavenworth KS VA Hospital, VA covered it up 15 months. They never care about pushing the victims through the process of getting the right help, having trauma evaluated, or seeing if other patients of same provider had trouble. Almost as bad as the murderous M.D. from Fort Hood. You think Army checks in on everyone else he treated or evaluated to see if they were traumatized? But this Kansas issue is out of control.
      Again, I want to thank you for speaking out, and I wish I could assist!

Comments are closed.