VA’s Veterans Health Administration (VHA) leaders have named 13 “gold status” practices following a competition held Nov. 16, 2016. These proven practices range from efforts that improve care coordination, such as increasing the availability of an opioid overdose treatment among clinical and community partners, to those that increase employee engagement, such as a new on-boarding program for VHA employees. Multiple practices focus on improving access to care and enhancing the Veteran experience, with an emphasis on serving rural Veterans.

Under Secretary for Health Dr. David Shulkin created the Diffusion of Excellence Initiative to identify and disseminate promising practices, as well as standardize those that promote positive outcomes for Veterans system-wide. As part of this initiative, a semi-annual competition solicits promising practices from front line VHA employees.

“Just in Time Cardiology: Improving Access Through Consult Triage”, a gold status practice developed by Dr. David Winchester from the North Florida/South Georgia Veterans Health Care System, requires physicians to review specialty care requests as soon as they are made. Depending on the Veteran’s condition, physicians may ask schedulers to schedule a traditional face-to-face appointment, or complete the request through an electronic consultation (e-consult). Through this practice, patients have fewer unnecessary appointments with specialists, but still have access to a specialist’s care when needed. During the first year of the program, while the amount of consultations and e-consults increased by 40 to 60 percent, the practice reduced wait times by 46 percent.

As gold status fellows, the employees who pioneered these practices will spend the next six months guiding another facility (or more than one) in adapting and implementing their practices. The fellows will participate in a three-day Diffusion of Excellence Summit in mid-January at the VHA SimLEARN National Simulation Center and Orlando VA Medical Center. During the summit, the fellows will work together with representatives from the new facility to develop action plans for implementation. Check out the VHA Twitter page for updates on their progress.

Image of a map showing the locations of where the winning programs will be implemented

VHA will roll out the most impactful practices across the VA health care system, supporting the goal of empowerment and improvement from the bottom up. Other impactful practices that may not have achieved “Gold Status” designation are being shared across VHA for implementation where they are needed.

Thank you to all finalists, medical center directors, and Veterans Integrated Service Network directors who participated in the competition, and congratulations to the second cohort of gold status fellows and implementing facilities. VHA will host a third competition later in 2017 to identify more promising practices, with the application period opening to VHA employees in the coming month.

For more background on the Diffusion of Excellence Initiative or the national competition, please see our recent blog and check out our Twitter Moment featuring live tweets from the event.

Congratulations to the following fellows and facilities:


Home-Based Mental Health Evaluation (HOME) Program for Rural Veterans

  • Gold Status Fellows: Mira Brancu, Durham VAMC (Durham, North Carolina) & Bridget Matarazzo, VA Eastern Colorado HCS (Denver, Colorado)
  • Implementing Facility: Wm. Jennings Bryan Dorn VAMC (Columbia, South Carolina)


Increasing Wound Care Access for Rural Veterans Through Telehealth

  • Gold Status Fellow: Mona Baharestani, Mountain Home VAMC (Mountain Home, Tennessee)
  • Implementing Facility: VA Montana HCS (Fort Harrison, Montana)


Just in Time Cardiology: Improving Access Through Consult Triage

  • Gold Status Fellow: David Winchester, North Florida/South Georgia VHCS (Gainesville, Florida)
  • Implementing Facility: Iowa City VA HCS (Iowa City, Iowa)


Care Coordination

Opioid Overdose Reversal through Rapid Availability of intranasal (IN) Naloxone to Patients, VA Police, and Within Automated External Defibrillator (AED) Cabinets

  • Gold Status Fellow: Pamela Bellino-Rivera, VA Boston HCS (Boston, Massachusetts)
  • Implementing Facility: VISN 8


Virtual Interprofessional Women’s Health Miniresidency

  • Gold Status Fellow: Carrie Kairys, VISN 8
  • Implementing Facility: VA Nebraska Western Iowa HCS (Omaha, Nebraska)


Image: VA Fresno congratulated Jesse Conyers and his team for the practice, Competency Tracker Program, achieving Gold Status in the USH Second Shark Tank Competition.

VA Fresno congratulated Jesse Conyers and his team for the practice, Competency Tracker Program, achieving Gold Status in the USH Second Shark Tank Competition.

Employee Engagement

Competency Tracker Program

  • Gold Status Fellow: Jesse Conyers, VA Central California HCS (Fresno, California)
  • Implementing Facilities: G.V. (Sonny) Montgomery VAMC (Jackson, MS) & Atlanta VAMC (Atlanta, Georgia)


Enhancing the Current State of Onboarding for Employee Engagement, Satisfaction, and Retention

  • Gold Status Fellow: Lisa Curnes, VA Central Iowa HCS (Des Moines, Iowa)
  • Implementing Facilities: Alaska VA HCS (Anchorage, AK) & Alexandria VA HCS (Alexandria, Louisiana)


Veterans Engagement: Reconnecting Employees with America’s Heroes

  • Gold Status Fellow: Judy Slivka, Louis Stokes Cleveland VAMC (Cleveland, Ohio)
  • Implementing Facility: VISN 17


Quality and Safety

E Consult Implementation: Impact of a Novel Screening and Transfer Process for Patients Seeking Substance Detoxification

  • Gold Status Fellow: Karthik Sivashanker, VA Boston HCS (Boston, Massachusetts)
  • Implementing Facility: Martinsburg VAMC (Martinsburg, West Virginia)


Prevention of Non-Ventilator Associated Hospital Acquired Pneumonia (NV-HAP) by Engaging Nursing Staff to Complete Oral Care

  • Gold Status Fellow: Shannon Munro, Salem VAMC (Salem, Virginia)
  • Implementing Facility: Michael E. DeBakey VAMC (Houston, Texas)


Veterans Experience

Chaplain Groups for Veterans with Moral Injury

  • Gold Status Fellow: Kerry Haynes, South Texas VHCS (San Antonio, Texas)
  • Implementing Facility: W.G. (Bill) Hefner VAMC (Salisbury, North Carolina)


My Life, My Story

  • Gold Status Fellow: Thor Ringler, William S. Middleton Memorial Veterans Hospital (Madison, Wisconsin)
  • Implementing Facilities: Durham VAMC (Durham, NC) & Atlanta VAMC (Atlanta, Georgia)


Pain University

  • Gold Status Fellow: Kristin Eneberg-Boldon, Tomah VAMC (Tomah, Wisconsin)
  • Implementing Facility: John D. Dingell VAMC (Detroit, Michigan)


 About the authors: Andrea Ippolito is the leader of the VA Innovators Network; Shereef Elnahal, MD, is the Assistant Deputy Under Secretary for Health for Quality, Safety, and Value; Frederick Kotler, MD, is the senior medical advisor for the VHA Office of Strategic Integration (OSI), and Sankalpa Subbu is a project manager for OSI.


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Published on Jan. 5, 2017

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