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PT/BRI QUERI Research-Operations Collaboration: Lessons Learned Through the Family Care Map Project Nina A. Sayer, PhD Research Coordinator, PT/BRI QUERI Core Investigator, CCDOR Barbara Sigford, MD, PhD Clinical Co-Coordinator, PT/BRI QUERI VHA National Director, PM&R. Outline.

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  1. PT/BRI QUERI Research-Operations Collaboration: Lessons Learned Through the Family Care Map Project Nina A. Sayer, PhDResearch Coordinator, PT/BRI QUERICore Investigator, CCDORBarbara Sigford, MD, PhDClinical Co-Coordinator, PT/BRI QUERIVHA National Director, PM&R

  2. Outline • Problem selection: Family Care within context polytrauma rehabilitation • Design selection: Use of a collaborative to develop and implement a web-based tool to improve family care (Family Care Map) • Success factors • Overcoming challenges • Recommendations for successful Operations-Research collaboration

  3. Problem Selection QUERI Steps 1-3 • Needs Assessment studies of 4 Polytrauma Rehabilitation Centers (PRCs: Minneapolis, Palo Alto, Richmond, Tampa) • Review scientific literature and government reports (OIG 2006 Report 05-01818-165) • Consultation with experts outside of VA • Executive Committee

  4. Problem Selection (continued) Findings from problem exploration stage: • Families play a significant role in inpatient rehabilitation, have high expectations, and have their own support and instrumental needs • Family dissatisfaction reflected in complaints • Level and type of family involvement and need were new for providers, contributing to high levels of provider stress • Variation in family care across sites • Operations felt urgency to improve family care due to stress in field and external stakeholder demands

  5. Problem Selection: Family Care High tension for change in area of family care • Families • Clinicians • External stakeholders (e.g. Congress, DoD, MTFs, service organizations) • Operations Conclusion: • Problem is severe and status quo is unacceptable • Problem area was consistent with QUERI mission and strategic plan

  6. Design Selection Context Exploration • Evidence: Limited but change urgently needed • Political: High level scrutiny • System/Organization: Leadership centralized, distance between operations and field minimal; Emphasis on reduction of variation within VHA • Team: Experts in new area; teams across sites interact; teams were change-oriented

  7. Family Care Collaborative Conclusion • Change needed across all 4 sites simultaneously and consistently • Change needed to leverage: • Clinician expertise and willingness to take action • Operations investment and relationship with the field • Researchers’ implementation, QI and facilitation expertise Family Care Collaborative • Representatives from 4 PRCs • Operations (Sigford, National Director PM&R) • Research (Hall, PT/BRI QUERI IRC)

  8. Collaborative Selection of Web-based Family Care Map to Improve Family Care • Successful implementation of web-based “family care map” in another context with some key similarities • Portability, accessibility, agility, and likely acceptability of web-based resource • Resources (from Operations and QUERI) sufficient • $ (and to lesser extent time) • Available expertise in web-development

  9. Indicators of Project Success • Implementation of pilot version of Family Care Map 8-months after first meeting of collaborative • Use of Family Care Map and integration into practice • Nursing competencies • Treatment plans and charting • Used for CARF • Workbooks for families • New staff education • Spread: Team cultural changes consistent with family-centered care; System now promotes family-centered care • Change in Operations view of how to train and disseminate • Process and outcome evaluation in progress; promising initial findings

  10. Success Factors • Chose the right problem within organizational context • Solution designed to help clinicians and operations with felt need; directly applicable • Stakeholder involvement in solution and implementation • Researchers did their homework (i.e., needs assessment) • Operations participation in/support for face to face workshops and planning for sustainability • Sufficient financial resources for workshops and site visits • Operations ongoing involvement with QUERI researchers • Relationship factors: Trust and respect

  11. Challenges to Collaboration within Project • External pressure to implement quickly • Time and competing demands • VA culture and policies promoting patient-centered as opposed to family-centered care • Problem complex; solution at first ambiguous • Need to develop an effective partnership • What is QUERI’s role? What is Operations role? • Is QUERI independent of Operations? • Building trust, earning respect

  12. Potential Challenges to Research-Operations Collaboration • Lack of Research-Operations partnership in… • Defining the critical problem • Allocating resources to the project (time and $) • Developing solution that fits organizational needs • Addressing barriers to solution implementation • Communicating about project and its impacts (positive and negative) • Exclusive focus on problems for which evidence-base is well-developed when improvement may be needed in areas for which evidence-base is not well-developed

  13. Overcoming Challenges during Implementation • Operations explicit support for project as a whole, timeline and clinician involvement (in our case memos to hospital Directors, discussion with Medical Directors at each site) • Researchers and Operations assumed joint responsibility for project • Open and ongoing communication about goals, resources and expectations • Operations and researcher flexibility in response to feedback and observations (plan not entirely fixed apriori) (in our case adjusted number clinical champions per site, changed non-VA facilitator, modified timeline, modified map content)

  14. Recommendations for Successful Collaboration • Identify a problem of high priority to operations, clinicians and the customer, even if the problem is complex and evidence-base is limited • Demonstrate joint commitment through resources (e.g., time, intellectual, material, social capital) • Develop a solution that benefits stakeholders • Select a design that is appropriate to the context • Remain uninvested in nature of the solution so long as it addresses the problem in its context • Honest and timely communication Trust and Respect

  15. Acknowledgements • Carmen Hall, IRC & Family Care Collaborative “Facilitator” • Implementation Framework: Organizational Change Manager (OCM) (Gustafson & Steudel, 1998-2008) • Family-Centered Care Map used in neonatology (Dunn et al. 2006) • PRC Family Care Map: http://www.hsrd.minneapolis.med.va.gov/FCM/

  16. Family Care Map Home Page

  17. Web Shot of FCM • Steps1-6

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