Innovating can be easy, but making it stick is hard. It takes more than money to get a great idea to sustainment, and there are multiple organizational and personality barriers that get in the way. What is key to overcoming the barriers and helping with end-user buy-in is an active partnership between innovators and local and national stakeholders.
In this issue, we feature strategic examples of innovators who secured support from the bottom up to implement promising practices in several VA sites. They were then paired with QUERI implementation experts to align the momentum with leadership support, and through rigorous evaluation are making the value proposition to local and national leaders on getting their innovations to sustainment across different VA sites.
Through these experiences QUERI has formed a great partnership with the Diffusion of Excellence, which seeks to empower the frontline by providing opportunities to innovate and be rewarded for these successes. In turn, QUERI strives to be a trusted purveyor of data and implementation expertise to further support these innovators by using time-tested implementation strategies to scale-up and spread their innovations across different settings. Many of these implementation strategies were highlighted in a recent HSR&D Evidence Review on Scaling Beyond Early Adopters and in the QUERI Implementation Roadmap, discussed in a recent Medical Care article (Kilbourne et al., 2019). Implementation strategies are also tools that help with change management at the local level, ensuring that innovations addressing national priorities work at the clinic level.
There are lessons learned from these partnerships. First, it is essential for innovators to empower and motivate their followers, who are crucial for showing others how the innovation works in their practice. Second, QUERI’s ability to conduct rigorous evaluations with a control group (showing what the world looks like without the innovation) is vital to making the business case to national leadership. High-quality, peer-reviewed evaluations through the QUERI program are crucial to VA’s compliance with the new Evidence-based Policymaking Act, which requires that all Cabinet-level agencies justify their budgets using evidence. Finally, QUERI linked innovators to national operations partners to garner additional support and, ultimately, to help with the future care and feeding of the innovations once the QUERI evaluation support goes away. In all, this strong and growing partnership is an ideal example of how VA is a Learning Health System—aligning frontline provider motivation to innovate with scientific rigor and implementation expertise to achieve better health and healthcare for Veterans.
Amy Kilbourne, PhD, MPH