Establishing a Research-Operations-Clinical

CollaborativePolytrauma Rehabilitation Centers’ Family Care

Collaborative: a Case Study

National QUERI MeetingDecember 11, 2008

Phoenix, AZ

Presenters:Carmen Hall, RN, PhD, Implementation Research Coordinator, PT/BRI

QUERI Barbara Sigford, MD, PhD, VHA PM&R National Director

Sharon Benedict, PhD, Rehabilitation Psychologist, RICVAMC

Objectives

Describe the: general context in which a research-operations-

clinical collaborative might be useful. roles and responsibilities of the research,

operations and clinical members. Explore challenges presented:

by clinical service and context; to traditional research approaches.

Describe how implementation can be supported with a research-operations-clinical collaborative.

Background

2005---Polytrauma Rehabilitation Centers 2005---Polytrauma Rehabilitation Centers 20062006

OIG reportOIG report Experiences of staff and familiesExperiences of staff and families QI informationQI information Research Research

Phase 1: Project Start

Family Care Advisory Group 1 - 2 representative / PRC PM&R leadership QUERI

Reviewed and discussed Research findings Good experiences/ staff and family Literature Interviews with experts

Roles

Operations Leadership Legitimacy Resources

Clinical Rehabilitation expertise Knowledge of patient care unit and experiences

QUERI FacilitationFacilitation ResourcesResources

Phase 2: Problem Exploration…

Aims and objectives identified Decrease variation in practice Decrease staff stress Increase family satisfaction with information Increase staff satisfaction with resources and

materials Increase staff efficacy working with families of

polytrauma patients

… Problem Exploration

Review data and information to date Review CARF rehabilitation guidelines Consult with external experts Possible solutions identified Stakeholder critique, feedback & input

April 2007-- Web-based intervention selected

May -- Meeting with expert panel

May – July ---local teams developing ideas for solution

Phase 3: Development ofIntervention

Web-based Family Care Map Structure Content Web-page

Stakeholder feedback Plan for evaluation Adaptation Improvement

Family Care Map Home Family Care Map Home PagePage

Web Web Shot Shot

of of FCMFCM

Steps1-6Steps1-6

Context

Stress Constant change Highly scrutinized

Able, committed team Support from all levels Interest and expectations across the organization Stressed families Not many families

Phase 4: Solution Implementation and Testing

Develop implementation plan National Pilot

Continuous evaluation Local adaptation of plan

Phase 6: Sustained Implementation

National Roll Out Central Office

Program Management Ongoing evaluation

Practice and Policy

Phase 5: Evaluation

Successes

Modify & adapt for unit clinical populations

Expand access across system of care

Expand & adapt application for other populations

Strengths

Synergy Engagement and involvement Multiple levels of leadership involved & aware Consistency in project leadership / culture Empower local change leader Principles of a learning organization---diversity Standardize yet accommodate local functional

variation Share resources --- Funding, staff, systems and

materials

Challenges…

Time to do the work Time to do the work PRC team changes PRC team changes External pressureExternal pressure Defining role of QUERI as change facilitatorDefining role of QUERI as change facilitator Conflict with non-VA facilitatorsConflict with non-VA facilitators Achieving consensusAchieving consensus Varied experience with QI methods and Varied experience with QI methods and

workshop formatworkshop format

… Challenges ---continued

Team very “patient-centered” Teams from different sites had limited

experience working together Limited support staff available to clinicians Small number of family “consumers” = small

n and large burden Multiple IRBs Consent families HIPAA

Key Success Factors…

High priority problem Trust

Clear, timely communication Follow through

Clear expectations Co-commitment Mutual respect

…Key Success Factors

Shared / mutual learning Change leaders leadership training Joint problem solving and intervention design Flexibility- adaptability Sufficient resources--- Funding, staff, time,

systems Guided by a model for organizational change

1. Project Start

Four Phases of Organizational Change

2. Problem Exploration

3. Solution Development

SolutionPlan

Successful Limited Change

4. Solution Implementation &

Testing

Modify / adapt ?

Family Care Collaborative Process

Research findings

CARF Guidelines

Problems identified

Family Care Advisory Group Formed• Supplementary data and info

• Good & bad experiences• Literature search• PI / QI / CQI info

Aims and goalsReview data to dateConsult with external expertsPossible solutions

Solution identified

Solution development &Iterative Stakeholder

feedback

Adaptation & improvement

Supplementary

analyses

Develop implementation plan

National Pilot • Continuous evaluation• Local adaptation of plan as needed

Pilot evaluation

Modify & adapt• for unit clinical populations• expand access across system of care & to other populations

Phase 6:

National Roll Out

Phase 1 Phase 2

Phase 3

Phase 4 Phase 5

1. Project Start

Phases of Family Care Change Initiative

Supplementary analyses

Supplementary analyses

Adapting or improving proposal

2. Problem Exploration

3. Solution Development

SolutionPlan

Successful Limited Change

National Roll-out

4. Solution Implementation &

Testing

Modify / adapt ?

Summary

Identified urgent need based on convergence Identified urgent need based on convergence of evidence about status quo of evidence about status quo

Undeveloped evidence base…Undeveloped evidence base… Creating foundation for practice-based evidenceCreating foundation for practice-based evidence

Polytrauma rehab experts within our systemPolytrauma rehab experts within our system Experts on FCC outside VAExperts on FCC outside VA Accelerated working together in a young Accelerated working together in a young

systemsystem Partnership Partnership

Acknowledgements

Members of VA Polytrauma Rehabilitation Centers’ Family Care Map Members of VA Polytrauma Rehabilitation Centers’ Family Care Map Collaborative Collaborative

Family members who shared their time to offer their input while Family members who shared their time to offer their input while participating in the rehabilitation of a loved one in one of the Polytrauma participating in the rehabilitation of a loved one in one of the Polytrauma Rehabilitation Center Rehabilitation Center

Maureen Reilly and the Family-Centered Care Map teams of the Maureen Reilly and the Family-Centered Care Map teams of the Vermont Oxford Network project Vermont Oxford Network project

Phil Kibort, MD, CMO & Julie Morath, RN, MS, COO (Children's Phil Kibort, MD, CMO & Julie Morath, RN, MS, COO (Children's Hospitals and Clinics of Minnesota)Hospitals and Clinics of Minnesota)

Steve Bergeson, MD, Allina Hospitals and ClinicsSteve Bergeson, MD, Allina Hospitals and Clinics Carol Levine, United Hospital Fund of NYCarol Levine, United Hospital Fund of NY Sue Aumer, PhD, CCDOR---FCM web-developer Sue Aumer, PhD, CCDOR---FCM web-developer

References

Institute for Healthcare Improvement. The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement.2003. Institute for Healthcare Improvement. Boston, MA.

Implementation Framework: Organizational Change Manager (OCM) (Gustafson & Steudel, 1998-2008)

Ovretveit J, Bate P, Cleary P, Cretin S, Gustafson D et al. Quality collaboratives: lessons from research. Qual Saf Health care. 2002; 11;345-351.

www.hsrd.minneapolis.med.va.gov/FCM