Faces of Innovation: From finalist in ‘Diffusion of Excellence’ to national implementation

The Faces of Innovation is a six-blog series about the Gold Status fellows and Implementing Facility fellows participating in the Diffusion of Excellence Initiative. This blog details two Gold Status fellows from the first cohort. The following blogs will include interviews with the current Gold Status Fellows and Implementing Facility Fellows.

It has been just over one year since the first cohort of Gold Status fellows and Implementing Facility fellows came together for the first Diffusion of Excellence Summit in March 2016. To get an inside look into how national deployment is progressing, we sat down with Dr. Ellina Seckel, Pham.D., and Vanessa Coronel, R.N.  Seckel is the Gold Status fellow for increasing access to primary care with pharmacists, and Coronel is the Gold Status fellow for a flu self-reporting desktop icon to capture employee vaccinations received outside of VA.

Seckel recognized that patients at the William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin, were waiting too long to see their primary care provider for chronic disease management. She created a multi-modal approach where clinical pharmacy specialists play a larger role in the care team, helping primary care provider s support patients and increasing Veterans’ access to care. This included initiating a new patient medication intake clinic, saving primary care providers 20 minutes during new patient appointments. The practice also converts chronic disease patient appointments from primary care providers to pharmacy specialists. In Madison, they were able to convert 27 percent of these appointments in the first three months, opening access to primary care appointments for acute patients.

Seckel noted that when spreading increasing access to primary care with pharmacists at El Paso, Texas, the team faced personnel difficulties. “During these instances,” she said, “it is important to have primary care support. It is not always the position you would expect that provides the most support. There were natural front line leaders that presented themselves to make the practice possible.”

Fifty-eight other VA and non-VA facilities (including one from England) have requested more information about the project.

At the end of 2016, the Diffusion of Excellence Initiative selected increasing access to primary care with pharmacists for national deployment across the Veterans Health Administration. With the project slated for national roll out, a national deployment team was formed including Seckel, the Clinical Pharmacy Practice Office and the Office of Strategic Integration’s Veterans Engineering Resource Center (OSI | VERC). If scaled nationally at all 166 VAMCs, the model has the potential to open 272,000 primary care provider appointments, save 228,064 primary care provider labor hours, and reduce costs by more than $4.6 million annually.

When asked about her experience working as a Gold Status fellow with El Paso VA Health Care System, Seckel noted that, “It was a whirlwind six months of helping [the Implementing Facility fellow] implement. I went to El Paso two times for two separate weeks for site visits and in the end, El Paso was just as successful as Madison in using pharmacists to increase access to care.”

In fact, El Paso VA HCS successfully completed phase-1 implementation. Additionally, Kansas City VAMC expressed interest in the practice, and is already collecting great data in phase-1 implementation. Seckel added, “So far [Kansas City] has saved 30.5 physician hours through the new patient calls; they are doing an added focus on population management resulting in improvements on every measure of A1c, blood pressures, and statin therapies for each of the phase-1 teams. They just received a physician email saying, ‘This has to be part of every team. I had no idea that my patient care could be enhanced.’”

Seckel recently attended the Diffusion of Excellence Summit in January 2017 at the Orlando VAMC and SimLEARN Center to support the second cohort in developing action plans to implement the 13 Gold Status practices. While at summit, she participated in a panel with other cohort-1 fellows to share advice and answer questions from attendees. When asked what advice she has for fellow VHA staff, Seckel noted the importance of “communication, teamwork, and co-design. Fellows have the responsibility to spread culture change, act as mentors, and advocate for front line staff, so that staff everywhere are empowered to make the kinds of changes fellows are able to make through the Diffusion of Excellence Initiative.”

Dr. Seckel continues to participate in and support the Diffusion of Excellence Initiative. Her cohort-1 colleagues recently nominated her to serve as a Gold Status Fellow ambassador on the Diffusion Council. The Diffusion Council is a group of VHA leaders responsible for providing advisement, support, and expertise for Diffusion of Excellence Initiative activities.

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Reporting flu vaccination received outside VHA used to be a labor-intensive process, requiring employees to wait in line at employee occupational health and manually fill out a form. There was no standard process, and many employees failed to report because of tedious manual entry protocols. Coronel her team at VA Boston Health Care System, implemented the Flu Self-Reporting desktop icon three years ago, aiming to increase flu vaccination reporting and encourage employee vaccinations, ultimately leading to safer and healthier care provided to Veterans. The practice provides a secured, simplified, standardized self-reporting process, which increases compliance of employee flu vaccinations and improves patient safety.

Nine months after being designated a Gold Status Practice, Coronel said, “The flu Icon had been replicated in eight VHA medical centers earlier but since gaining national exposure from Dr. Shulkin’s initiative, the number of replications and inquiries grew leaps and bounds in a matter of months. It is now in 67 facilities – a third of America’s largest integrated health care system. Add the 31 that are actively replicating, the Flu Icon will soon cover two-thirds of VHA.”

At the end of 2016, the Diffusion of Excellence Initiative chose the Flu Icon for national deployment across VHA. To date, 67 medical centers have implemented successful replications, 31 medical centers are in the process of implementing, and another 34 medical centers have inquired about implementing the practice. VHA Occupational Health Program Office, which is the executive sponsor for this practice, submitted the business summary report to the requirements development and management office to gain approval to continue to move forward with implementing the Boston version of the Flu Icon nationally, specifically with regards to removing the IT barriers from the regions that are facing implementation roadblocks.

Sotonya Motton, program specialist for OSI | VERC, serves as the project manager for the national deployment of the practice noted that, “Ms. Coronel has been an instrumental part of the Flu Icon project team, as she has assisted with offering guidance and instructions to other VHA Employee Occupational Health staff who are interested in implementing this practice at their VAMCs. She has also assisted with keeping the Flu Icon page updated with the latest facility implementations and Flu Desktop Icon highlights, and she is helping with the transition of this practice over to the VHA Occupational Health Program Office.”

From her experience as a Gold Status Fellow, Coronel emphasized that it is imperative for stakeholders to present a united front. She also shared three key aspects of successful implementation: “Identify stakeholders, identify barriers, and identify ways to manage those barriers”. She also stated, “Simplification is a hallmark of a high reliability organization; the Flu Icon achieves this simplicity by making the lives of VHA employees easier by simplifying the flu vaccination reporting process so VHA employees save time.”

At the Diffusion of Excellence Summit, Coronel said, “The Diffusion Initiative, it kind of reaffirms and validates what I have known about VHA: Veterans have earned and deserved the best care that they could get, and VHA strives to provide the best care.”

When asked to provide advice to new and aspiring Gold Status Fellows, Coronel emphasized that VHA employees “are very lucky we have this platform of sharing best practices and diffusing them across VHA. It is an honor because whatever best project can happen at the front line, you actually have the opportunity to spread it across the entire country. The front line is heard; changes from the grassroots are happening.”

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Seckel and Coronel’s success with the national deployment of their Gold Status practices demonstrates the amazing impact the Diffusion of Excellence Initiative has had in improving care for Veterans. Congratulations to both.

During his tenure as 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 systemwide. The Diffusion of Excellence Initiative empowers employees to share innovations and drive a supportive culture of continuous improvement. Through the Initiative, VHA has identified more than 1,000 practices submitted by frontline staff that address VA’s priorities of improving access, care coordination, employee engagement, quality and safety, and the Veteran experience.

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Tiana Bouma joined VA as a contractor in 2016. She works for Atlas Research, a consulting firm providing strategic advisory and applied research services to federal health and social service agencies based in Washington, D.C.