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Amy Kilbourne, PhD, MPH, Director of QUERI

Director's Letter

VA employs more than 300,000 individuals, of which 59% are women and 33% are Veterans, making VA the largest single healthcare employer in the United States. VA also is the largest single trainer of healthcare professionals, including physicians, nurses, clinical psychologists, and social workers, and of the majority of U.S. physicians have had experience in VA care and electronic health records. Given the major transformations occurring in VA, Dr. David Shulkin, VA Under Secretary for Health, has made employee engagement a national priority. Moreover, providing VA clinicians the methods to promote quality improvement is an essential component of what the National Academy of Medicine (formerly Institute of Medicine) has called a Learning Health Care System.

For the past 17 years, QUERI's goal has been to support providers in the implementation of research into practice. Our recently updated National Strategic Plan has many goals supporting providers, including the engagement of more frontline providers implementing evidence-based practices using quality improvement methods. Supporting 28 Programs and Partnered Evaluation Initiatives (PEIs) from across the U.S. led by over 60 academically-affiliated VA investigators, QUERI strives to support frontline providers through the testing of the best tools or strategies to help implement effective treatments into practice. Implementation strategies are highly-specified, theory-based tools or methods that are designed to help providers and teams of providers overcome barriers to adoption of new programs or clinical practices (e.g., ranging from resource limitations to provider burnout), or in some cases, de-implement ineffective or low-value practices.

Many cutting-edge implementation strategies are currently being used across the 12 QUERI Programs, which serve as "laboratories" to refine and test implementation strategies that are based on principles of Lean Six Sigma, Facilitation (Provider Coaching), Public Health Models, and Community/Stakeholder Engagement. In turn, these implementation strategies can be further used and adopted to implement best practices, such as through the Under Secretary's Promising Practices Consortium.

This issue of QUERI eNews (QNews) highlights innovative implementation strategies that draw upon QUERI's extensive experience with research-operations partnerships that hold promise in improving care coordination in post-hospitalization care and mental health. Other innovative methods focused on provider interprofessional learning also are presented. With VHA clinical operations, QUERI also co-funds time-sensitive evaluations of national program and policy implementation efforts through the Partnered Evaluation Initiative. Current Partnered Initiatives include Nurse Staffing Methodologies and the Veterans Choice Act's Group Practice Manager (Section 303) program.

Overall, QUERI investigators are at the forefront of VA's efforts toward a Learning Health System, notably by bridging quality improvement and implementation science to support frontline providers. We will accomplish this by deploying methods and evaluation techniques to promote the uptake and continuous improvement of best practices that ultimately reduce variation in quality and improve the overall health and healthcare for Veterans.

Amy Kilbourne, Ph.D., M.P.H.
Director, Quality Enhancement Research Initiative