Centralized oversight for clinical performance improvement: a pilot initiative at the Lexington VAMC.

Abstract

In July 2000 the Lexington Veterans Affairs Medical Center (Lexington, Ky) centralized oversight of clinical performance improvement (CPI) activities by creating an office of clinical operations (OCO) to improve patient care and operational efficiency. The OCO was designed to eliminate redundancy of effort, correct resource underuse and overuse, and improve the communication of change initiatives and successes. Before 2000 no formal process existed for creating interdisciplinary CPI teams. Lack of organizational oversight for CPI activities had also led to duplication of effort, mixed accountability, and difficulty in remaining focused on organizational goals. CREATING THE OCO: OCO staff have led and facilitated numerous projects, all of which involved interdisciplinary teams consisting of physician and nurse leaders, users, and support staff. The OCO has also developed a utilization management plan for the entire medical center. The OCO formally interfaces with three major arenas of medical center operation: clinical processes, patient safety, and cost-efficiency. A major effort of OCO staff has been to learn about data availability and access and to determine how data can be used in a meaningful way to benefit CPI project teams. The creation of the OCO precipitated the typical cultural integration problems that are often encountered with the introduction of new organizational entities that lack existing turf.