An organizational framework and strategic implementation for system-level change to enhance research-based practice: QUERI Series

Cheryl B Stetler¹ , Lynn McQueen² , John Demakis³ and Brian S Mittman⁴

¹Independent Consultant, Amherst, Massachusetts, USA

²Office of Quality and Performance, U.S. Department of Veterans Affairs, Washington DC, USA

³(Retired) Health Services Research and Development Service, U.S. Department of Veterans Affairs, Washington, DC, USA

⁴VA Center for the Study of Healthcare Provider Behavior, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA

author email corresponding author email

Implementation Science 2008, 3:30doi:10.1186/1748-5908-3-30


Published:	29 May 2008

Abstract

Background

The continuing gap between available evidence and current practice in health care reinforces the need for more effective solutions, in particular related to organizational context. Considerable advances have been made within the U.S. Veterans Health Administration (VA) in systematically implementing evidence into practice. These advances have been achieved through a system-level program focused on collaboration and partnerships among policy makers, clinicians, and researchers.

The Quality Enhancement Research Initiative (QUERI) was created to generate research-driven initiatives that directly enhance health care quality within the VA and, simultaneously, contribute to the field of implementation science. This paradigm-shifting effort provided a natural laboratory for exploring organizational change processes. This article describes the underlying change framework and implementation strategy used to operationalize QUERI.

Strategic approach to organizational change

QUERI used an evidence-based organizational framework focused on three contextual elements: 1) cultural norms and values, in this case related to the role of health services researchers in evidence-based quality improvement; 2) capacity, in this case among researchers and key partners to engage in implementation research; 3) and supportive infrastructures to reinforce expectations for change and to sustain new behaviors as part of the norm. As part of a QUERI Series in Implementation Science, this article describes the framework's application in an innovative integration of health services research, policy, and clinical care delivery.

Conclusion

QUERI's experience and success provide a case study in organizational change. It demonstrates that progress requires a strategic, systems-based effort. QUERI's evidence-based initiative involved a deliberate cultural shift, requiring ongoing commitment in multiple forms and at multiple levels. VA's commitment to QUERI came in the form of visionary leadership, targeted allocation of resources, infrastructure refinements, innovative peer review and study methods, and direct involvement of key stakeholders. Stakeholders included both those providing and managing clinical care, as well as those producing relevant evidence within the health care system. The organizational framework and related implementation interventions used to achieve contextual change resulted in engaged investigators and enhanced uptake of research knowledge. QUERI's approach and progress provide working hypotheses for others pursuing similar system-wide efforts to routinely achieve evidence-based care.