Peter A. Woodbridge, MD, MBADirector, MidWest Mountain Veterans Engineering Resource CenterACOS for Quality and Medical Effectiveness, Nebraska Western Iowa VA Health Care SystemAssistant Professor, Health Services Research and Administration, UNMC College of Public Health

MidWest Mountain VERC Overview

The Veterans Engineering Resource Centers (VERC)

Rooted in a research / medical center operations collaboration Grounded in NAE/IOM 2005 recommendations* Proof of concept – engineering student projects Highly visible transformative improvements

Four VERC with budgets of ~$500K to $1.5M each established June 2009 Funded with medical care appropriations Resource centers

Provide applied operations systems engineering support

Engage faculty to develop novel operations systems engineering in support transformative improvement

* NAE/IOM, Building a Better Delivery System: A New Engineering Health Care Partnership. 2005

MWM VERC: Multi-VISN / Multi-University / HSRD Partnership

VISN V12, 18, 19, 23 14 mid-west and

mountain states 1.2M Veterans 24 medical centers

HSRD IDEAS REAP CRICC REAP

Affiliated Universities ASU Creighton University MSU NMSU NDSU U Colorado, Denver U Iowa U Minnesota U Nebraska, Lincoln UNMC U Wisconsin, Madison 27 faculty

Why a Multi-VISN, Multi-University VERC?

Intractable healthcare systems problems Defy simple process improvement or managerial solutions Generate unintended disruption of other systems Require consideration of process, structure, and patterns Solutions fail to spread and / or be sustained

MWM VERC Vision: The Healthcare Work Place of the Future

All staff have the knowledge, capabilities, and desire to strive continuously for excellence Educate healthcare workers in systematic approach to

value improvement Make healthcare an attractive career for graduating

engineering students Systems and processes are engineered for

excellence Error-proofed, error-recovering and self-healing Integrated as patient-centered systems rather than linked,

discrete processes Expertise, not bounded by geography, coalesces to

solve intractable healthcare systems problems in diverse, multi-talented, teams

Achieving Excellence Healthcare is “complex” –

not “complicated*” Processes, structures, and

patterns matter* Process – the steps to

taken to complete a task Structures – the policies,

equipment, etc. that support processes

Patterns – the organizational context surrounding the processes and structures (e.g., relationships, beliefs, traditions, etc.)

*Paul Plsek “Complexity and the Adoption of Innovation in Health Care” AHRQ, 2003

MWM VERC: Organizational Goals

Provide support across the entire SR/QI continuum “Essential” SR / QI knowledge projects Applied engineering projects Academic engineering projects

Ensure a pipeline of OSE to enter VHA service

Provide OSE support for SR collaboration and knowledge sharing

The Role of SR/OSE

VERC Improvement Metaphors

Essential SR / QI

Applied Engineering

Academic Engineering

Share knowledge Discover knowledge Create knowledge

Train Assist Consult

Spread and sustain Improve Innovate

Quality assurance Quality planning Quality improvement

Reactive Corrective Preventive

Fix past Optimize present Improve future

Defined Concrete Conceptual

Off the shelf Customize Develop

MWM VERC Goals & Projects:

T21 – “Develop capabilities and enabling systems to drive performance and outcomes”

Essential SR / QI Projects Educate the healthcare work force of the future Improvement methods ontology Lean healthcare implementation and training

Applied OSE Projects EHR documentation in support of PCMH Inpatient staffing optimization Reusable medical equipment ISO-9000 compliance Technical engineering assistance consultation service

Academic OSE Projects SR virtual collaboration social computing environment Teamwork during emergencies

SR Virtual Collaboration Social Computing Environment

MWM VERC Goals & Projects:

T21 – “Expand access for Veterans including women and rural

populations” Applied OSE

Advanced scheduling Centralized vs. decentralized scheduling Clinic space optimization

Academic OSE Agent based modeling of rural health access Improve rural mental health access and

effectiveness through tele-medicine

MWM VERC Goals & Projects:

T21 – “Design a Veteran-centric healthcare model and right sized infrastructure to help navigate the healthcare delivery

system” Applied OSE

Patient centered medical home collaborative Clinic telephone response optimization

collaborative Improving clinic visit efficiency

Academic OSE Dual care for rural veterans Coordinating care across the continuum

Status Report MWM VERC Projects

Active projects: 19 VERC funded projects: 15 Project deliverables received to date: 139

OSE Engagement Funded OSE faculty: 15 Funded OSE universities: 9

OSE trainees engaged in VHA MWM VERC projects Undergraduates: 15 Masters students: 18 PhD students: 10 Post Doctoral: 2

The MWM VERC Leadership Team

Leadership Peter Woodbridge,

MD, MBA, Director Jennifer Wagner, PhD,

DD Academic Engineering & Research

Chris Masek, DD Applied Engineering

Mike Rubin, MD, AD Academic Engineering & Research

Brian Hertz, MD, AD Applied Engineering

Staff Eric Aldinger,

Administrative Officer Bryan Gamble, Project

Manager Gary Kiel, Program

Analyst Ann Fetrick, Research

Coordinator TBD. Lean Program

Manager TBD, IE Chicago TBD, IE Phoenix

Comments?

Contact information:

peter.woodbridge@va.gov