Sixteen Finalists entered the waters for the 2021 VHA Shark Tank Competition and, after the exciting live Veterans Health Administration (VHA) Innovation Experience (iEX) event, 10 have emerged as the next cohort of Promising Practices for the VHA Innovation Ecosystem Diffusion of Excellence. These 10 Promising Practices impact all aspects of Veteran care from a simple, standardized approach to VA operating room preparations to a high-tech approach to cancer care.

During iEX the sixteen Finalists presented their practices to VHA Sharks, who then made incredible bids to take a bite of innovation and implement the practice in their facility. As with previous cohorts, the winning Finalists, called Diffusion of Excellence Fellows (DFs), will work with counterparts from each Implementing Facility, known as Implementing Facility Fellows (IFFs). Each IFF will champion the implementation of the Promising Practice at their facility, working with the DF and the Diffusion of Excellence Team to successfully adapt and replicate their project over six to 12 months. Everything kicks off when the DF and IFF meet for the first time at the upcoming Diffusion of Excellence Base Camp.

These 10 Promising Practices will join the 69 previous winners in impacting Veteran lives across VHA. Previous VHA Shark Tank Competition winning Promising Practices have been replicated more than 830 times across the country with 13 of them moving into National Diffusion, breaking boundaries and forging the future of Veteran care.

2021 VHA Shark Tank Winners

Implementation of a Billing Resolution Center

Originating Site: VISN 10 VA Central Ohio Healthcare System (HCS)
Implementing Site: VISN 7 Central Alabama Veterans Healthcare System

Beginning July 2020, we began a process to resolve billing concerns resulting in over $2.5 million dollars in erroneous claims corrected for over 300 Veterans to date. Our resolution team instituted monthly meetings with our top five (by disbursed amount) vendors and encouraged utilization of available resources, including Health Share Referral Management (HSRM). We established weekly meetings with all staff involved in billing to ensure resolution of issues and addressing of erroneous billing situations. The team hired a billing resolution specialist as AMSA (Advanced Medical Support Specialist) to meet with Veterans in-person. Consolidated Patient Account Center (CPAC) staff are now imbedded and focused on VA copayment education and repayment options. By reaching out to our vendors in the community, we are re-establishing trust and building relationships that are instrumental as we navigate new community care needs. We have seen our Survey of Healthcare Experiences of Patients (SHEP) scores related to community care billing increase in almost all areas to exceed national standards since implementation of the Billing Resolution Center.

Cancer Prevention at Your Fingertips, Empowering Veterans Through Mobile Application

Originating Site: VISN 16 Michael E. DeBakey VA Medical Center (VAMC)
Implementing Site: VISN 12 Captain James A. Lovell Federal Health Care Center

In the United States, colorectal cancer (CRC) is the third leading cause of cancer-related deaths in men and women, and the second most common cause of cancer deaths when men and women are combined. As a “digital front door” to address this phenomenon, the “Annie” app uses a series of navigational reminders for optimal performance with colonoscopies, devising an inclusive means of combating the growing burden of cancer through early detection and prevention. Now, the organization has in place the components of an effective no-show mitigation strategy – driving our strategic priorities as a High-Reliability Organization (HRO) – as Annie empowers, educates and engages each Veteran from the convenience of their home.

Colorectal Cancer Screening with Programmatic Mailed Fecal Immunochemical Test

Originating Site: VISN 21 and National Gastroenterology Program Office
Implementing Site: VISN 17 Amarillo VA Health Care System

Screening is proven to reduce mortality from colorectal cancer (CRC), the second leading cause of cancer death in the United States. Unfortunately, hundreds of thousands of Veterans are unscreened, and the COVID-19 pandemic has exacerbated this problem, with approximately 1.6 million Veterans due for screening in 2021. To address this still-growing backlog, we have initiated a program to mail fecal immunochemical test (FIT) kits for CRC screening directly to our Veterans to use in their homes and mail back for analysis. Veteran and provider acceptance has been very positive.

We believe our FIT-first approach, modeled after the successful Kaiser Permanente program, will increase CRC screening adherence, reduce overall costs, increase colonoscopy access for Veterans with the highest risk for CRC and ultimately save lives.

Compassionate Contact Corps

Originating Facility/Site: VISN 10 VA Central Ohio HCS
Implementing Sites: VISN 8 VA Sunshine Healthcare Network and VISN 16 Central Arkansas Veterans Healthcare System

The Compassionate Contact Corps is a social prescription program that offers friendly phone and video visits between trained volunteers and Veterans. The volunteer calls their matched Veteran once per week to provide compassionate conversation and companionship. This program has proven to reduce loneliness and improve overall well-being in Veterans.

Inpatient Fall Prevention Real-Time Monitoring

Originating Site: VISN 21 and The National Center for Collaborative Healthcare Innovation (NCCHI)
Implementing Sites: VISN 2 Bath VA Medical Center and VISN 4 VA Pittsburgh Healthcare System

Falls among hospital inpatients are common, generally ranging from 2.3 to 7 falls per 1,000 patient days. Approximately 30 percent of inpatient falls result in injury, with 4 percent to 6 percent resulting in serious injury. These serious fall-related injuries can include fractures, subdural hematomas, excessive bleeding and even death.

The prevention of falls in the hospital setting is important for patient safety and public health. NCCHI is working to assess, integrate and quantify novel fall prevention technology – specifically, a system validated for our Veteran population, VA Infrastructure and clinical and operational workflows.

Wielding these technologies, NCCHI is collaborating with a medical company on an exciting project that utilizes its smart integrated sock sensor system to alert nurses when a fall-risk patient attempts to get out of bed. The design is optimized for efficient clinical response, and nurses are empowered to be in the right place at the right time.

Implementation of Syringe Service Programs

Originating Site: VA Illiana Health Care System
Implementing Site: VISN 1 VA Boston Healthcare System

Syringe Service Programs (SSPs) were created to better apply harm reduction techniques in VA. We aim to encompass people who use drugs (PWUD), encompassing injection and non-injection methods (i.e., snorting, smoking) and opioids and non-opioids (e.g., methamphetamine, cocaine). Material items will include sterile equipment, supplies, naloxone and patient education, but the links to general health care, including primary and specialty care, could hold the greatest potential. Overall, SSPs serve to engage a stigmatized and vulnerable population and improve their long-term health and well-being.

We have escalated this project from the local level and a smaller, rural-serving site in Danville, IL (closest Syringe Service Programs >1 hour away), to one that has national support with the Office of Mental Health and Suicide Prevention, the Office of General Counsel and the HIV, Hepatitis, and Related Conditions Programs. With many facilities nationwide rolling out, we are involved in a VA-funded research study to evaluate SSP and Harm Reduction implementation in VA. This is a vital opportunity to bring culture change to VA and for VA to serve as a model for other large, federal institutions to follow our lead.

Mini-Cog© Screening Tool: Early Identification of Patient with Cognitive Impairment

Originating Site: VISN 8 The Villages Outpatient Clinic
Implementing Site: VISN 23 Iowa City VA Health Care System

The Mini-Cog© is a three-minute use instrument that can increase the detection of cognitive impairment in older adults. It can be used effectively after a brief training in both health care and community settings.

The goal of screening for cognitive impairment in primary care is to find patients whose cognitive deficits have gone unnoticed or unrecorded in routine clinical encounters. Symptoms may be severe enough to interfere with the patient’s self-care and medical management.

Nursing implementation of the Mini-Cog© tool provides an easy and consistent process for early recognition of cognitive impairment. This results in the appropriate referrals to provide early diagnosis, differential and treatment. Early treatment can provide improved patient outcomes by slowing or delaying disease progression, which has been shown to improve the quality of life for both the patient and their family while allowing additional time for important decision-making and planning.

THRIVE: Transforming Health and Resiliency through Integration of Values-based Experiences

Originating Site: VISN 8 James A. Haley Veterans’ Hospital
Implementing Site: VISN 7 Central Alabama Veterans Health Care System

THRIVE is a 14-week curriculum-based Shared Medical Appointment for Veterans developed from evidence-based principles of Whole Health, Positive Psychology and Acceptance & Commitment Therapy. THRIVE is a Whole Health clinical offering that improves Veterans’ health, well-being and health care experience; enhances employee satisfaction and retention; and improves the facility’s bottom line. In a 100-percent virtual platform, THRIVE enables more Veterans to experience the benefits of an effective program that builds resilience, improves health and creates community.

VA Operating Room Preparation Standardization

Originating Site: VISN 9 Lexington VAMC
Implementing Site: VISN 8 VA Sunshine Healthcare Network

Operating Room setups were found to be nearly 100% variable and inefficient, creating frustration amongst staff when switching for lunches, breaks and shifts. By working with key stakeholders, our team of experts created standard operating procedures utilizing the leading theories in visual management. This decreased variation to nearly zero and increased efficiency by nearly 50%.

Virtual Reality for Pain and Anxiety Management

Originating Site: VISN 6 Charles George VA Medical Center
Originating Site: Western North Carolina VA HCS
Implementing Site: VISN 5 Beckley VA Medical Center

Virtual Reality as a distraction modality utilizes three-dimensional, computer-generated environments and 360-degree video footage in an immersive head-mounted display to transport Veterans to a world where their negative stressors do not exist. This capability enables licensed clinical staff to aid Veterans with pain and anxiety management, improve relaxation and improve the experience of being in a health care facility. Virtual environments include interactive games, peaceful natural environments, and even footage familiar to our Veterans—including Western North Carolina’s well-known mountain tops to make our Veterans feel more at home within our walls. Since project planning began in late 2017, over 300 sessions have been completed in multiple patient areas; 58.3% of participating Veterans experienced a decrease in acute and/or chronic pain, and 92.5% of Veterans experienced a decrease in stress/anxiety levels.

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