Implementation and sustainment of diverse practices in a large integrated health system: a mixed methods study
Abstract Background One goal of health systems seeking to evolve into learning health systems is to accelerate the implementation and sustainment of evidence-based practices (EBPs). As part of this evolution, the Veterans Health Administration (VHA) developed the Innovation Ecosystem, which includes...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2020-07-01
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| Series: | Implementation Science Communications |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s43058-020-00053-1 |
| _version_ | 1818862570658856960 |
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| author | Andrea L. Nevedal Caitlin M. Reardon George L. Jackson Sarah L. Cutrona Brandolyn White Allen L. Gifford Elizabeth Orvek Kathryn DeLaughter Lindsay White Heather A. King Blake Henderson Ryan Vega Laura Damschroder |
| author_facet | Andrea L. Nevedal Caitlin M. Reardon George L. Jackson Sarah L. Cutrona Brandolyn White Allen L. Gifford Elizabeth Orvek Kathryn DeLaughter Lindsay White Heather A. King Blake Henderson Ryan Vega Laura Damschroder |
| author_sort | Andrea L. Nevedal |
| collection | DOAJ |
| description | Abstract Background One goal of health systems seeking to evolve into learning health systems is to accelerate the implementation and sustainment of evidence-based practices (EBPs). As part of this evolution, the Veterans Health Administration (VHA) developed the Innovation Ecosystem, which includes the Diffusion of Excellence (DoE), a program that identifies and diffuses Gold Status Practices (GSPs) across facilities. The DoE hosts an annual “Shark Tank” competition in which leaders bid on the opportunity to implement a GSP with 6 months of implementation support. Over 750 diverse practices were submitted in cohorts 2 and 3 of Shark Tank; 23 were designated GSPs and were implemented in 31 VA networks or facilities. As part of a national evaluation of the DoE, we identified factors contributing to GSP implementation and sustainment. Methods Our sequential mixed methods evaluation of cohorts 2 and 3 of Shark Tank included semi-structured interviews with at least one representative from 30/31 implementing teams (N = 78/105 people invited) and survey responses from 29/31 teams (N = 39/47 invited). Interviews focused on factors influencing implementation and future sustainment. Surveys focused on sustainment 1.5–2 years after implementation. The Consolidated Framework for Implementation Research (CFIR) informed data collection and directed content analysis. Ordinal scales were developed inductively to rank implementation and sustainment outcomes. Results Over 50% of teams (17/30) successfully implemented their GSP within the 6-month implementation period. Despite extensive implementation support, significant barriers related to centralized decision-making, staffing, and resources led to partial (n = 6) or no (n = 7) implementation for the remaining teams. While 12/17 initially successful implementation teams reported sustained use of their GSP, over half of the initially unsuccessful teams (n = 7/13) also reported sustained GSP use 1.5 years after the initial implementation period. When asked at 6 months, 18/27 teams with complete data accurately anticipated their future sustainability based on reported sustainment an average of 1.5 years later. Conclusions Most teams implemented within 6 months and/or sustained their GSP 1.5 years later. High levels of implementation and sustainment across diverse practices and teams suggest that VHA’s DoE is a successful large-scale model of diffusion. Team predictions about sustainability after the first 6 months of implementation provide a promising early assessment and point of intervention to increase sustainability. |
| first_indexed | 2024-12-19T10:01:58Z |
| format | Article |
| id | doaj.art-48082b4828704485b2bd6324684cf880 |
| institution | Directory Open Access Journal |
| issn | 2662-2211 |
| language | English |
| last_indexed | 2024-12-19T10:01:58Z |
| publishDate | 2020-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science Communications |
| spelling | doaj.art-48082b4828704485b2bd6324684cf8802022-12-21T20:26:38ZengBMCImplementation Science Communications2662-22112020-07-011111310.1186/s43058-020-00053-1Implementation and sustainment of diverse practices in a large integrated health system: a mixed methods studyAndrea L. Nevedal0Caitlin M. Reardon1George L. Jackson2Sarah L. Cutrona3Brandolyn White4Allen L. Gifford5Elizabeth Orvek6Kathryn DeLaughter7Lindsay White8Heather A. King9Blake Henderson10Ryan Vega11Laura Damschroder12Center for Innovation to Implementation, VHA Palo Alto Health Care SystemCenter for Clinical Management Research, VHA Ann Arbor Healthcare SystemDurham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VHA Health Care SystemCenter for Healthcare Organization & Implementation Research, Bedford & Boston VHA Medical CentersDurham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VHA Health Care SystemCenter for Healthcare Organization & Implementation Research, Bedford & Boston VHA Medical CentersCenter for Healthcare Organization & Implementation Research, Bedford & Boston VHA Medical CentersCenter for Healthcare Organization & Implementation Research, Bedford & Boston VHA Medical CentersCenter for Healthcare Organization & Implementation Research, Bedford & Boston VHA Medical CentersDurham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VHA Health Care SystemDiffusion of Excellence, VHA Innovation EcosystemVHA Office of Discovery, Education and Affiliate NetworksCenter for Clinical Management Research, VHA Ann Arbor Healthcare SystemAbstract Background One goal of health systems seeking to evolve into learning health systems is to accelerate the implementation and sustainment of evidence-based practices (EBPs). As part of this evolution, the Veterans Health Administration (VHA) developed the Innovation Ecosystem, which includes the Diffusion of Excellence (DoE), a program that identifies and diffuses Gold Status Practices (GSPs) across facilities. The DoE hosts an annual “Shark Tank” competition in which leaders bid on the opportunity to implement a GSP with 6 months of implementation support. Over 750 diverse practices were submitted in cohorts 2 and 3 of Shark Tank; 23 were designated GSPs and were implemented in 31 VA networks or facilities. As part of a national evaluation of the DoE, we identified factors contributing to GSP implementation and sustainment. Methods Our sequential mixed methods evaluation of cohorts 2 and 3 of Shark Tank included semi-structured interviews with at least one representative from 30/31 implementing teams (N = 78/105 people invited) and survey responses from 29/31 teams (N = 39/47 invited). Interviews focused on factors influencing implementation and future sustainment. Surveys focused on sustainment 1.5–2 years after implementation. The Consolidated Framework for Implementation Research (CFIR) informed data collection and directed content analysis. Ordinal scales were developed inductively to rank implementation and sustainment outcomes. Results Over 50% of teams (17/30) successfully implemented their GSP within the 6-month implementation period. Despite extensive implementation support, significant barriers related to centralized decision-making, staffing, and resources led to partial (n = 6) or no (n = 7) implementation for the remaining teams. While 12/17 initially successful implementation teams reported sustained use of their GSP, over half of the initially unsuccessful teams (n = 7/13) also reported sustained GSP use 1.5 years after the initial implementation period. When asked at 6 months, 18/27 teams with complete data accurately anticipated their future sustainability based on reported sustainment an average of 1.5 years later. Conclusions Most teams implemented within 6 months and/or sustained their GSP 1.5 years later. High levels of implementation and sustainment across diverse practices and teams suggest that VHA’s DoE is a successful large-scale model of diffusion. Team predictions about sustainability after the first 6 months of implementation provide a promising early assessment and point of intervention to increase sustainability.https://doi.org/10.1186/s43058-020-00053-1Consolidated Framework for Implementation Research (CFIR)Qualitative methodsModel of diffusionSustainabilityLearning health systemVeterans |
| spellingShingle | Andrea L. Nevedal Caitlin M. Reardon George L. Jackson Sarah L. Cutrona Brandolyn White Allen L. Gifford Elizabeth Orvek Kathryn DeLaughter Lindsay White Heather A. King Blake Henderson Ryan Vega Laura Damschroder Implementation and sustainment of diverse practices in a large integrated health system: a mixed methods study Implementation Science Communications Consolidated Framework for Implementation Research (CFIR) Qualitative methods Model of diffusion Sustainability Learning health system Veterans |
| title | Implementation and sustainment of diverse practices in a large integrated health system: a mixed methods study |
| title_full | Implementation and sustainment of diverse practices in a large integrated health system: a mixed methods study |
| title_fullStr | Implementation and sustainment of diverse practices in a large integrated health system: a mixed methods study |
| title_full_unstemmed | Implementation and sustainment of diverse practices in a large integrated health system: a mixed methods study |
| title_short | Implementation and sustainment of diverse practices in a large integrated health system: a mixed methods study |
| title_sort | implementation and sustainment of diverse practices in a large integrated health system a mixed methods study |
| topic | Consolidated Framework for Implementation Research (CFIR) Qualitative methods Model of diffusion Sustainability Learning health system Veterans |
| url | https://doi.org/10.1186/s43058-020-00053-1 |
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