Spreading Innovations Across VA

Diffusing Excellence to Improve Veterans’ Experiences Daily

Improving Veteran experiences and outcomes is paramount in our efforts. And our frontline employees are critical for affecting these improvements. Employees are the beating heart of VA. They are the ones who understand all too well the challenges faced by our Veterans when they access healthcare. It is also these employees, who on their own accord, step forward with new ideas. They innovate. They ignite change that improves the experiences of Veterans and those who serve them. They see and solve problems at their local medical centers and offices.

Now, through the Veterans Health Administration (VHA) Diffusion of Excellence Initiative, dedicated frontline employees are influencing outcomes far beyond their individual workplaces. The Initiative leverages the Innovators Network and VHA Innovations Program as catalysts to stimulate and promote innovation. It also recognizes staff who are already developing innovative best practice solutions to some of the agency’s biggest problems. In doing so, VA is empowering its top performers to help reapply their innovative best practices throughout the system.

For the second year in a row, employees from every level across the VA healthcare system were encouraged to submit their innovative solutions into the “VA Shark Tank” competition. These solutions must show improvements of access and care coordination for Veterans, improved quality and safety, or helped engage employees.

More than 435 submissions were received — a two-fold increase since the first round last year.

After reviewing the Medical Center and VISN Director “Shark” bids from the Under Secretary for Health (USH) Second Shark Tank Competition on November 16, 2016, the USH and VHA Leadership selected 13 Gold Status practices and 15 Implementing Facilities. Over 150 viewers joined the virtual Competition to watch the 20 Finalists pitch their inspiring and innovative practices to approximately 50 Medical Center and VISN Director Sharks. In total, Sharks placed 127 bids on the practices.

In last year’s very first Diffusion of Excellence Planning Summit, Gold Status Fellows and Implementing Facility Fellows came from across the US to co-develop Implementation Plans for implementation in under 6 months!

What comes next? Gold Status Fellows, the employees who pioneered these practices will spend the next six months guiding another “Implementing 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.

Gold Status Fellow Kristine Gherardi and others receive coin from USH David Shulkin for her “Code Tray Redesign”

What is it like to be a Gold Status Fellow? Kristine Gherardi, 1st Cohort Gold Status Fellow and innovator of the Code Tray Redesign, explains: “It’s a humbling experience to be a Gold Status Fellow. I never thought that I would make it to Washington. It’s exciting. It’s surreal. What Secretary McDonald is trying to do I think is phenomenal because I have worked in the private sector and I know how things work in the private sector. And if you bring some of these ideas to light in the VA, and you merge them with the VA core values, you’re just going to blow up. It’s just going to be awesome.”

Gold Status Fellow Kristine Gherardi and others receive coin from USH David Shulkin for her “Code Tray Redesign”

The USH will host another Shark Tank Competition in the spring of 2017, with the application period opening in January.

Congratulations again to the second cohort of USH Fellows, and thank you to the Finalists and Sharks who participated in the USH Second Shark Tank Competition!

Here are the Gold Status Fellows and the facilities that will champion the spread of these practices that will help our Veterans:


Home-Based Mental Health Evaluation (HOME) Program for Rural Veterans. HOME staff meet with the hospitalized Veterans and conduct a telephone call and home visit during the first week post-discharge. Staff maintain at least weekly telephone contact until the Veteran is engaged in mental health care.

· 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. The Tele-Wound program provides rural Veterans with wound diagnosis and treatment via e-consults, clinical video telehealth, and Store-and-Forward telehealth, which eliminates the travel burden and reduces the risk of infection and hospitalization for Veterans.

· 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. This new model of triaging consult requests requires physicians to review specialty consult requests at the time of the order. Depending on the Veteran’s condition, physicians may triage the Veteran’s request for a face-to-face encounter, e-consult, or answer clinical questions electronically.

· Gold Status Fellow: David Winchester, North Florida/South Georgia VHCS (Gainesville, Florida)

· Implementing Facility: Iowa City VA HCS (Iowa City, Iowa)


Chaplain Groups for Veterans with Moral Injury. Chaplains use two types of group visits for Veterans diagnosed with Posttraumatic Stress Disorder (PTSD) and those struggling with service-connected moral injury. The first group is spiritually based and accessible without an appointment. The second group is a closed group with a higher level of commitment for Veterans to engage in spiritual and psychological interventions to combat lingering guilt and shame.

· 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. Program staff and trained community volunteers conduct interviews and write a short story about the Veteran’s life. With the Veteran’s approval, the stories are added to their electronic health record (EHR) and shared with the Veteran’s inpatient and primary care teams.

· 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. To address VA’s lack of a comprehensive chronic pain management program, Rehabilitation and Patient Care Services staff use a new model for conducting pain management services that includes an integrated and streamlined process for referral management and a standardized chronic pain patient education program.

· Gold Status Fellow: Kristin Eneberg-Boldon, Tomah VAMC (Tomah, Wisconsin)

· Implementing Facility: John D. Dingell VAMC (Detroit, Michigan)


Opioid Overdose Reversal through Rapid Availability of intranasal (IN) Naloxone to Patients, VA Police, and Within Automated External Defibrillator (AED) Cabinets. To address the high incidence of opioid overdoses, VA Boston HCS educates staff, Veterans, and other interested parties on the proper administration of intranasal naloxone and distributes the drug for increased access to 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. Uses a pre-set curriculum from the Office of Women’s Health Education to increase the number of physicians trained to care for female Veterans. The curriculum enhances provider’s skills and allows primary care providers (PCPs) and nurses to receive the training necessary to become Designated Women’s Health Providers (DWHPs).

· Gold Status Fellow: Carrie Kairys, VISN 8

· Implementing Facility: VA Nebraska Western Iowa HCS (Omaha, Nebraska)


Competency Tracker Program. Uses a customized board to track and display employee competencies, further engaging staff and providing visibility into employee’s competencies at-a-glance. This program allows users to track employee performance, quickly identify competent coverage for call-ins/no-shows and employees on leave, and assess new areas to focus training.

· 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. The JumpStart new hire onboarding program incorporates a dedicated new hire welcome website and expands the facility-coaching program to include matching new hires with experienced coaches.

· 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. To reconnect employees with VA’s mission, the program gives staff members, who do not normally interact with Veterans, the opportunity to spend a day meeting Veterans and hearing their stories. Staff members, who engage with Veterans daily, facilitate the interactions with the Veterans. After spending time with Veterans, the employees gather to discuss their experiences in small groups.

· Gold Status Fellow: Judy Slivka, Louis Stokes Cleveland VAMC (Cleveland, Ohio)

· Implementing Facility: VISN 17


E Consult Implementation: Impact of a Novel Screening and Transfer Process for Patients Seeking Substance Detoxification. Due to a lack of effective guidelines for screening patients for substance detox, the psychosomatic medicine service team improves the transfer process for Veterans seeking medically managed substance detoxification through an enhanced screening transfer algorithm.

· 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. To prevent non-ventilator associated hospital acquired pneumonia (NV-HAP), clinicians collaborate with dental services to improve oral care for hospitalized Veterans, addressing the association between the oral microbiome and development of pneumonia. By improving teeth brushing among hospitalized Veterans, the team reduced the number of cases of NV-HAP in their facility by 70 percent.

· Gold Status Fellow: Shannon Munro, Salem VAMC (Salem, Virginia)

· Implementing Facility: Michael E. DeBakey VAMC (Houston, Texas)

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