The LEAP Program: Quality Improvement Training to Address Team Readiness Gaps Identified by Implementation Science Findings

Jennifer A Burns,Susan D Raffa,Claire H Robinson,Julie C Lowery,Laura J Damschroder,Michelle B Freitag,Nicholas R Yankey

doi:10.1007/s11606-020-06133-1

Abstract

BackgroundIntegrating evidence-based innovations (EBIs) into sustained use is challenging; most implementations in health systems fail. Increasing frontline teams’ quality improvement (QI) capability may increase the implementation readiness and success of EBI implementation.ObjectivesDevelop a QI training program (“Learn. Engage. Act. Process.” (LEAP)) and evaluate its impact on frontline obesity treatment teams to improve treatment delivered within the Veterans Health Administration (VHA).DesignThis was a pre-post evaluation of the LEAP program. MOVE! coordinators (N = 68) were invited to participate in LEAP; 24 were randomly assigned to four starting times. MOVE! coordinators formed teams to work on improvement aims. Pre-post surveys assessed team organizational readiness for implementing change and self-rated QI skills. Program satisfaction, assignment completion, and aim achievement were also evaluated.ParticipantsVHA facility-based MOVE! teams.InterventionsLEAP is a 21-week QI training program. Core components include audit and feedback reports, structured curriculum, coaching and learning community, and online platform.Main MeasuresOrganizational readiness for implementing change (ORIC); self-rated QI skills before and after LEAP; assignment completion and aim achievement; program satisfaction.Key ResultsSeventeen of 24 randomized teams participated in LEAP. Participants' self-ratings across six categories of QI skills increased after completing LEAP (p< 0.0001). The ORIC measure showed no statistically significant change overall; the change efficacy subscale marginally improved (p < 0.08), and the change commitment subscale remained the same (p = 0.66). Depending on the assignment, 35 to 100% of teams completed the assignment. Nine teams achieved their aim. Most team members were satisfied or very satisfied (81–89%) with the LEAP components, 74% intended to continue using QI methods, and 81% planned to continue improvement work.ConclusionsLEAP is scalable and does not require travel or time away from clinical responsibilities. While QI skills improved among participating teams and most completed the work, they struggled to do so amid competing clinical priorities.

Highlights

Integrating evidence-based innovations (EBIs) into sustained use is a well-documented challenge for health systems
Twenty-four programs were randomly selected from the list of MOVE! coordinators who expressed interest in participating in Learn. Engage. Act. Process.” (LEAP) and assigned to one of four starting dates
Invitations were emailed to MOVE! coordinators of 68 randomly selected group MOVE! programs

Summary

Introduction

Integrating evidence-based innovations (EBIs) into sustained use is a well-documented challenge for health systems. Integrating evidence-based innovations (EBIs) into sustained use is challenging; most implementations in health systems fail. Act. Process.” (LEAP)) and evaluate its impact on frontline obesity treatment teams to improve treatment delivered within the Veterans Health Administration (VHA). DESIGN: This was a pre-post evaluation of the LEAP program. Pre-post surveys assessed team organizational readiness for implementing change and selfrated QI skills. Assignment completion, and aim achievement were evaluated. MAIN MEASURES: Organizational readiness for implementing change (ORIC); self-rated QI skills before and after LEAP; assignment completion and aim achievement; program satisfaction. Participants' self-ratings across six categories of QI skills increased after completing LEAP (p< 0.0001)

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