1078 — VHA Diffusion of Excellence: Motivation and Context for Development of Innovative Practices

Lead/Presenter: Brandolyn White,  COIN - Durham
All Authors: Jackson GL (Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham; Duke University), White BS (Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham), Cutrona SL (Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston; UMass Medical School) Reardon CM (Center for Clinical Management Research (CCMR), Ann Arbor) Nevedal A (Center for Innovation to Implementation (Ci2i), Palo Alto) King HA (Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham; Duke University) Vega R (Veterans Health Administration (VHA) Innovation Ecosystem) Lindquist J (Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham) Gifford AL (Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston; Boston University) DeLaughter K (Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston; UMass Medical School) Orvek E (Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston; UMass Medical School) White L (Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston) Henderson B (Veterans Health Administration (VHA) Innovation Ecosystem) Damschroder LJ (Center for Clinical Management Research (CCMR), Ann Arbor)

Objectives:
The Veterans Health Administration (VHA) strives to empower frontline staff to develop innovations and practices to improve outcomes for Veterans and staff. The VHA Diffusion of Excellence (DoE) program works to identify these practices for potential spread throughout the VHA by asking staff from across the VHA to submit successful practices to a "Shark Tank" competition, in which VHA facility and regional directors bid on the opportunity to implement one of these practices with external facilitation support. In the first four rounds, 1,676 promising practices were submitted and 47 were designated as Gold Status Practices (GSPs). We sought to examine the motivations for developing and seeking to spread practices/innovations.

Methods:
We conducted semi-structured telephone interviews with 22 of 23 Gold Status Facility Fellows (GSFFs) [staff that developed practices (30 individuals)] for GSPs identified through the second and third Shark Tank. Data were collected and analyzed using the Consolidated Framework for Implementation Research and Weiner Theory of Organizational Readiness for Change.

Results:
GSFFs were typically intrinsically motivated (Personal Readiness) to develop practices when they identified a staff and/or patient need though personal observations (Tension for Change). While there were reports of corresponding performance measures and supporting research (External Policies and Incentives), most felt a personal and professional duty to help improve VHA systems and processes to provide the best care and experiences possible to Veterans (Patient Needs and Resources). They collaboratively developed best practices, which resulted in strong support from staff (Engaging: Key Stakeholders). In addition, facility leaders provided resources to make implementation possible (Available Resources) and created an environment in which staff felt safe to try new things because e.g., they were encouraged by their clinical leaders to innovate (Learning Climate). Successful implementation in Gold Status Facilities and a desire to enhance processes across the system, with encouragement from leaders, led them to share the practice in the Shark Tank.

Implications:
Intrinsic motivation of frontline staff for developing and implementing new innovations/practices, coupled with supportive contextual factors, all contributed to achieving GSP designation.

Impacts:
These findings point to opportunities to leverage individual intrinsic motivation to develop and spread innovations.