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2019 HSR&D/QUERI National Conference Abstract

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2002 — VHA's High Reliability Organization (HRO) Initiative: Identifying Strategic and Tactical Evaluation Goals

Lead/Presenter: Laura Damschroder,  COIN - Ann Arbor
All Authors: Damschroder LJ, PROVE QUERI; Cox G, MHA Deputy Under Secretary for Health for Organizational Excellence; Watts BV, Acting Assistant Deputy Under Secretary for Quality, Safety, and Value; Gunnar W, Executive Director, National Center for Patient Safety; Mannozzi C, Supervisory Analyst, RAPID-Performance Measurement Office;

The Veterans Health Administration (VHA) has launched a system-wide initiative to achieve High Reliability Organization (HRO) status throughout all levels of the VHA. An HRO Summit was convened in February to kick-off the initiative with executive Directors from all 18 VISNs and Directors from 18 medical centers; one within each VISN. The interest is so strong, that another 18 VISNs will be added to this forward vanguard of facilities ready to begin their journey to HRO. The HRO framework has three Pillars: 1) Leadership commitment; 2) culture of safety; and 3) process improvement guided by five Principles; 1) Sensitivity to Operations; 2) Preoccupation with Failure; 3) Reluctance to Simplify; 4) Commitment to Resilience; and 5) Deference to Expertise; and seven Values; 1) It's about the Veteran, 2) Support a Safety Culture, 3) Commit to Zero Harm, 4) Learn, Inspire, and Improve, 5) Duty to Speak Up, 6) Respect for People, and 7) Clear Communications. The objective of this partnered forum is to convene operations partners and research experts to collaboratively develop strategic evaluation goals and tactical steps for how to achieve those goals. The ultimate aim for this forum is to map a path forward in a way that helps operations partners and researchers work together to achieve system impacts that will be greater than either group working alone.

This forum will be highly interactive, using brainstorming and problem-solving approaches commonly used in co-design (refer to of innovations and processes. Laura Damschroder will be the lead facilitator and will engage participants in Affinity Mapping (aka "KJ Technique") and similar exercises that are designed to generate ideas for how to address each of three key topics listed below. First, participants will engage in brainstorming with the goal of generating as many ideas as possible. Participants will then cluster ideas into categories and agree on labels for each category. They will then prioritize these categories based on key criteria; e.g., importance, feasibility. The session will be designed to move from generating ideas to articulating high-level prioritized roadmaps for addressing knowledge gaps and helping VHA achieve its HRO goals. This process was used successfully in a recently convened State of the Art Conference (SOTA) related to Embedded Research with leaders from health systems and research entities in the U.S. The forum will be structured to address the following topics. First, results from a rapid review, completed by Portland VA's Evidence Synthesis Program Coordinating Center (ESP CC; led by Ms. Veazie) will be presented. The goals of this rapid review were to synthesize peer-reviewed literature on HRO frameworks, metrics, and implementation effects. Dr. Cox, Dr. Watts, Dr. Gunnar, and Mr. Mannozzi will each describe VHA current state with respect to the VHA's HRO operational framework, performance metrics, and define HRO impact goals. Participants will be engaged to identify high-priority knowledge gaps to address within each of three areas: 1) strategic frameworks to guide implementation; 2) metrics to assess progress toward system goals; 3) tracking impact of HRO on the system and for Veterans. The last half-hour of the session will be dedicated to developing a summary to report back to HSRandD.


Target audience includes additional operational partners interested in supporting HRO, along with researchers with expertise and/or interest in organizational development, performance measurement, and/or maximizing quality and safety of health care delivery for Veterans within an HRO framework.

Products from this forum will be designed to guide researchers in helping operational partners assess progress toward achieving success related to becoming an HRO. Outputs will include a summary of how research outputs can directly help our operations partners achieve their goals including impacts on national policies and Veteran and organizational impacts. This information will provide a roadmap by which to design QUERI partnered evaluations and for HSRandD researchers to address longer-term needs and goals related to VHA delivery systems becoming HROs.