MidWest Mountain VERC Overview Peter A. Woodbridge, MD, MBA Director, MidWest Mountain Veterans Engineering Resource Center ACOS for Quality and Medical Effectiveness, Nebraska Western Iowa VA Health Care System Assistant Professor, Health Services Research and Administration, UNMC College of Public Health

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 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 OSE Engagement 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 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