Abstract
BackgroundSuccessful implementation of new clinical programs depends on effectively establishing, reorganizing, or enhancing team structures and processes to coordinate the work of individuals who are interdependent in their tasks, manage relationships, and share responsibility for outcomes. However, a one-size-fits-all approach is rarely effective. In partnership with VA national clinical leaders and local clinical champions, the Optimizing Function and Independence VA Quality Enhancement Research Initiative program (Function QUERI) will evaluate efforts to implement team-based clinical programs for Veterans at risk for functional decline and disability.MethodsFunction QUERI will implement and evaluate three innovative, evidence-based clinical programs in VA medical centers: (1) a group physical therapy program for knee osteoarthritis (Group PT); (2) assisted early mobility for hospitalized older veterans (STRIDE), a supervised walking program for hospitalized older veterans; and (3) implementation of helping invested family members improve veteran experiences study (iHI-FIVES), a skills training program for caregivers of disabled Veterans. A common reason for clinical care gaps in these populations is poor communication and coordination among the many interdisciplinary providers involved in their care. To facilitate the implementation of the clinical programs, Function QUERI will evaluate the impact of complexity science-based implementation intervention to promote team readiness (CONNECT), an implementation intervention designed as a bundle of interaction-oriented activities to promote team function and readiness for change, on the implementation of clinical programs across multiple sites. The evaluation will use a mixed methods design. Group PT is a local, single-site quality improvement project where a modified CONNECT intervention will be tested to inform the remaining program implementation projects. For STRIDE and iHI-FIVES projects, we will randomize participating sites to implement the clinical program, with the CONNECT intervention or not, and will use a stepped-wedge cluster randomized trial design.DiscussionFunction QUERI will translate its findings across its projects to identify the contextual factors and components from CONNECT that improve team processes and function to optimize effective implementation for future rollout of VA clinical programs. Synthesizing findings within and across projects, we will specify dimensions of team characteristics and function that enhance capacity for clinical innovation and uptake of evidence-based programs.Trial registrationNCT03300336 Registered September 28, 2017, NCT03474380 Registered March 15, 2018.
Highlights
Successful implementation of new clinical programs depends on effectively establishing, reorganizing, or enhancing team structures and processes to coordinate the work of individuals who are interdependent in their tasks, manage relationships, and share responsibility for outcomes
Consistent with an emerging literature indicating that team process and effectiveness are associated with improvements in patient-centered care [6], the Optimizing Function and Independence Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) program will evaluate the impact of teams on the implementation and effectiveness of new clinical programs in specialized and acute care settings for patients at risk for impairment of function and independence
The three clinical programs will be implemented as quality improvement (QI) projects, and the evaluation will be conducted as human subjects research approved by the Durham VA Health Care System Institutional Review Board
Summary
Successful implementation of new clinical programs depends on effectively establishing, reorganizing, or enhancing team structures and processes to coordinate the work of individuals who are interdependent in their tasks, manage relationships, and share responsibility for outcomes. Clinical improvement efforts require team structure that coordinates the work of individuals who are interdependent in their tasks, manage relationships within one or more social systems (e.g., service line, facility), and share responsibility for outcomes. Consistent with an emerging literature indicating that team process and effectiveness are associated with improvements in patient-centered care [6], the Optimizing Function and Independence VA Quality Enhancement Research Initiative (QUERI) program (hereafter Function QUERI) will evaluate the impact of teams on the implementation and effectiveness of new clinical programs in specialized and acute care settings for patients at risk for impairment of function and independence. Function QUERI will test an intervention designed to improve team function and readiness for change, as a strategy for promoting effective implementation of Function QUERI’s clinical programs
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