Lauren S Penney1, Jessica L Moreau2, Isomi Miake-Lye2, Davis Lewis3, Adrian D'Amico3, Kelli Lee4, Brianna Scott5, Susan Kirsh6, Kristina M Cordasco7. 1. Veterans Evidence-Based Research Dissemination Implementation Center, South Texas Veterans Health Care System, San Antonio, TX, USA; Department of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA. Electronic address: Lauren.Penney@va.gov. 2. VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. 3. VA Pittsburgh Healthcare System, Pittsburgh, PA, USA. 4. VA Office of Healthcare Transformation, Pittsburgh, PA, USA. 5. VA Pittsburgh Healthcare System, Pittsburgh, PA, USA; VA Office of Healthcare Transformation, Pittsburgh, PA, USA. 6. Office of Veterans Access to Care, Veterans Health Administration, Washington, DC, USA; Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA. 7. VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
Abstract
BACKGROUND: Champions frequently facilitate change in healthcare, but the literature lacks specificity regarding champion activities and interactions with local contexts. The Veterans' Health Administration (VA) Emergency Department (ED) Rapid Access Clinic (ED-RAC) initiative used champions to spread an innovation aimed at achieving timely specialty follow-up care for ED patients. We assessed the roles champions and local contexts played in successful ED-RAC spread in the initiative's first year. METHODS: Our mixed method formative evaluation included serial questionnaires, fieldnotes from meetings, and champion interviews. We analyzed qualitative data from spread site rapid and non-rapid implementers, assessing champion and contextual factors. RESULTS: Among 24 participating VA sites, 11 were rapid implementers (i.e., implemented ED-RAC in first year), 13 were not. Site champions at rapid sites described crossing multiple organizational units to get tasks accomplished (e.g., gaining buy-in, requesting resources); champions at non-rapid sites experienced inter-departmental communication challenges and competing demands. Champions at rapid and non-rapid sites encountered similar context-related barriers (e.g. scheduling complexities) and facilitators (e.g. enthusiastic buy-in), but differed in leadership and resource barriers. CONCLUSIONS: Identifying site champions was not enough to assure rapid innovation spread. Interdependencies between ED-RAC implementation requirements (e.g., boundary spanning, resources) and champion and contextual factors helped explain variations in progress. IMPLICATIONS: Tailoring spread support to champion and contextual factors may facilitate more rapid spread of innovations. Published by Elsevier Inc.
BACKGROUND: Champions frequently facilitate change in healthcare, but the literature lacks specificity regarding champion activities and interactions with local contexts. The Veterans' Health Administration (VA) Emergency Department (ED) Rapid Access Clinic (ED-RAC) initiative used champions to spread an innovation aimed at achieving timely specialty follow-up care for ED patients. We assessed the roles champions and local contexts played in successful ED-RAC spread in the initiative's first year. METHODS: Our mixed method formative evaluation included serial questionnaires, fieldnotes from meetings, and champion interviews. We analyzed qualitative data from spread site rapid and non-rapid implementers, assessing champion and contextual factors. RESULTS: Among 24 participating VA sites, 11 were rapid implementers (i.e., implemented ED-RAC in first year), 13 were not. Site champions at rapid sites described crossing multiple organizational units to get tasks accomplished (e.g., gaining buy-in, requesting resources); champions at non-rapid sites experienced inter-departmental communication challenges and competing demands. Champions at rapid and non-rapid sites encountered similar context-related barriers (e.g. scheduling complexities) and facilitators (e.g. enthusiastic buy-in), but differed in leadership and resource barriers. CONCLUSIONS: Identifying site champions was not enough to assure rapid innovation spread. Interdependencies between ED-RAC implementation requirements (e.g., boundary spanning, resources) and champion and contextual factors helped explain variations in progress. IMPLICATIONS: Tailoring spread support to champion and contextual factors may facilitate more rapid spread of innovations. Published by Elsevier Inc.
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Keywords:
Care coordination; Emergency medicine; Facilitation; Implementation science; Qualitative