QUERI – Quality Enhancement Research Initiative

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Lean Enterprise Transformation Evaluation Initiative

Boston, MA and Palo Alto, CA

Overview:

VA's Veterans Engineering Resource Centers (VERCs) are implementing a national program of Lean Enterprise Transformation (LET). The objective is to embed Lean principles, strategies, practices, and behaviors in VA medical centers to improve healthcare quality and efficiency. This QUERI-supported initiative is evaluating LET implementation initially in 10 sites and will begin data collection early in fiscal year 2016. Investigators will assess improvement initiatives, measure organization-level transformation, and identify factors that both facilitate and hinder program success. Investigators will work closely with VERC partners and sites to determine strategies for measurement and to implement findings into practice.

Objectives:

This QUERI Initiative will evaluate LET implementation with the following aims:

  • Measure the baseline of both organizational transformation and value streams at each of the 10 participating sites and at comparison sites;
  • Design a comprehensive, independent evaluation strategy that provides a standardized approach to evaluating current and planned LET sites;
  • Assess the implementation of strategic initiatives, and variations in implementation success across sites, in order to inform successful implementation of future initiatives;
  • Identify the specific contextual characteristics and deployment mechanisms that facilitate success of LET programs at the levels of continuous daily improvements, value streams and throughout the medical center;
  • Examine provider and staff level barriers and facilitators to adoption of Lean Management Systems (e.g., knowledge, attitudes, experience); and
  • Determine if and how LET programs result in the transformation of key aspects of an organization (i.e., culture) to promote a learning organization.

Methodology:

Investigators will employ a mixed-methods design. Through initial site visits, review of outcomes data, and a survey to staff and managers, they will measure the baseline of both organizational transformation and value streams at each site. Investigators also will conduct additional site visits at intervals of 6 months to assess the success of rapid improvement events and other interventions in value streams, as well as overall organizational transformation, and will identify factors that affect change. Through administration of an annual staff survey, they also will assess changes in maturity and transformation at the sites. Using these data, investigators will assess improvement success. Where data permit, they will compare value stream improvements across sites - and relate that success to background, context, and implementation factors. The investigators will work with partners to design a comprehensive, independent evaluation strategy that provides a standardized approach to evaluating current pilot and planned LET sites.

Operations Partner: The Veterans Engineering Resource Centers (VERC) are responsible for applying engineering and improvement methods to important healthcare problems so the VA can efficiently, effectively, and reliably provide exceptional care to Veterans. This includes training VHA staff and new professionals in improvement methods that can be applied to healthcare.

Principal Investigator: Martin Charns, DBA; contact at Martin.Charns@va.gov; co-Principal Investigator: Anita Vashi, MD, MPH; contact at Anita.Vashi@va.gov.