Research and Operations: Joining Forces to Improve Care for Veterans

Abstract

The Veterans Health Administration's move to adopt a joint operations-research perspective in promoting clinical innovation in the health care system has led to an increasing number of researchers, clinicians, and policy leaders collaborating on quality improvement activities. We describe 2 such programs, both aimed at improving care for older veterans, which were conducted by teams with both research and operations experience. We explore differences in perspectives, contributions, and roles of various team members, as well as discuss benefits and challenges of research-operations partnerships in quality improvement activities. Growth is never by mere chance; it is the result of forces working together.James Cash Penney The Veterans Health Administration (VHA) is committed to continually improving the care delivered to America's veterans [1]. Advancing health care innovation has long been a shared goal of many of VHA's program offices, clinicians, and managers (hereafter referred to as operations), as well as research programs such as Health Services Research and Development (HSR&D). Although aligned in purpose in many instances, operations and research have historically worked separately [2]. Lack of communication and cooperation between these groups has contributed to occurrences of health care research not being relevant to key stakeholders, initiation of new clinical programs and policies without supporting evidence or evaluation, and delays in translation of research findings into practice.The need to join forces to spur health care innovation that is rapid, relevant, and evidence-based has been recognized for some time. Fortunately, successful examples of research-operations partnerships are becoming more common. HSR&D and the Quality Enhancement Research Initiative (QUERI) have emphasized partnered research as a major strategy for enhancing the value and impact of health care research [2]. This has led to many new studies developed jointly with input from stakeholders in clinical and policy roles, with various levels of engagement from partners [3]. There are also notable recent examples of operations tapping researchers to evaluate new clinical programs or initiatives, such as the implementation of the patient-centered medical home and the lung cancer screening program [4,5].VHA's move to adopt a joint operations-research perspective in promoting clinical innovation in the health care system is also evident in the increasing number of researchers, clinicians, and policy leaders collaborating on quality improvement (QI) activities. As part of its Transformation to the 21st Century Non-institutional Long Term Care (T21 NILTC) initiative, the VHA Office of Geriatrics and Extended Care (GEC) has funded more than 167 clinical demonstration projects since 2010 to support innovative programs intended to reduce the need for institutional care among older veterans. Importantly, while these projects were not research and there was no mandate for input from researchers, rigorous evaluation was encouraged in order t...

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Early Mobility in the Hospital: Lessons Learned from the STRIDE Program

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“…Based on the cumulative evidence on early mobility and the positive results from the STRIDE demonstration, Durham VAHCS established STRIDE as a permanent clinical service in 2013 [23].…”