[CLASSICAL MUSIC PLAYING]
ANNOUNCER: WELCOME TO "VHA EXCELLENCE IN HEALTH CARE"
WITH DR. RYAN VEGA,
DR. ELLINA SECKEL,
AND YOUR HOST JACOB GADD.
TODAY'S EDITION--
"DIFFUSION OF EXCELLENCE."
HELLO. I'M JACOB GADD.
WELCOME TO "VHA EXCELLENCE IN HEALTH CARE."
MY GUESTS TODAY ARE: DR. RYAN VEGA,
DIFFUSION OF EXCELLENCE LEAD FROM THE RICHMOND
VA MEDICAL CENTER;
AND DR. ELLINA SECKEL, ASSOCIATE CHIEF OF PHARMACY
AND GOLD STATUS FELLOW FROM THE MADISON VA MEDICAL CENTER.
WELCOME TO YOU BOTH, AND, RYAN,
SO LET'S BEGIN WITH OUR FIRST QUESTION,
AND THAT IS, YOU KNOW, TELL US A LITTLE BIT
ABOUT THE DIFFUSION OF EXCELLENCE INITIATIVE,
HOW IT STARTED,
AND WHERE THE PROGRAM CURRENTLY IS TODAY.
RYAN: YEAH, JACOB. THANK YOU.
SO THE DIFFUSION OF EXCELLENCE WAS AN INITIATIVE STARTED BY
DR. SHEREEF ELNAHAL A COUPLE OF YEARS AGO,
AND REALLY AT ITS CORE, THE CONCEPT IS HOW DO WE SPREAD
PROMISING AND BEST PRACTICES ACROSS VHA, UNDERSTANDING THAT
WE'RE THE LARGEST INTEGRATED HEALTH SYSTEM IN THE COUNTRY
SEPARATED GEOGRAPHICALLY BY SOMETIMES VERY
LARGE DISTANCES,
AND IT'S THE SIMPLE MODEL OF HOW IS SOMETHING THAT'S GOING
ON IN ALABAMA IMPACTING VETERANS REPLICATED
IN CALIFORNIA?
OR VIRGINIA AND WASHINGTON,
BUT I THINK TRULY AT ITS CORE WHAT IT REALLY IS IT'S A MODEL
AND A MECHANISM FOR US TO ALLOW FRONTLINE TALENTED
EMPLOYEES LIKE ELLINA TO TACKLE SOME OF THE TOUGH
CHALLENGES THAT THE VA's FACING, COME UP
WITH THE SOLUTIONS,
AND CONNECT THEM ACROSS THE ENTERPRISE,
SO TO SPEAK, TO REALLY IMPACT THE VETERAN EXPERIENCE AND TO
MAKE SURE THAT THAT IS STANDARD ACROSS SITES.
AND SO I THINK REALLY THAT'S REALLY THE NOVEL
AND THE INNOVATIVE ASPECT OF IT IS IT'S BUILDING THAT
NETWORK, REALLY PROMOTING AND ELEVATING FRONTLINE EMPLOYEES
WHO ARE IN THE TRENCHES, WHO SEE THE CHALLENGES.
WE SOMETIMES--LEADERSHIP SOMETIMES ARE DISCUSSING THEM.
THEY'RE THE ONES WITH THE SOLUTIONS AND THE ANSWERS.
SO GO TO THEM AND ALLOW THEM TO KIND OF SOLVE SOME
OF THE CHALLENGES AND SPREAD THOSE INITIATIVES ACROSS
THE HEALTH SYSTEM.
JACOB: AND IT WAS BASED OFF OF THE ABC "SHARK TANK."
SO TELL US A LITTLE BIT MORE ABOUT HOW THE "SHARK TANK"
ACTUALLY IS PART OF THE PROGRAM.
RYAN: YEAH. SO WE JUST FINISHED OUR THIRD
"SHARK TANK," AND IT'S A REALLY GREAT CONCEPT BECAUSE I THINK
IT'S SOMETHING THAT EVERYBODY CAN SORT OF RALLY AROUND.
THE OTHER THING THAT'S REALLY UNIQUE ABOUT IT IS IT BRINGS
SOME OF THE LEADERSHIP INTO IT.
SO THE MEDICAL CENTER DIRECTORS ARE THE SHARKS.
THEY'RE THE INDIVIDUALS WHO ARE BIDDING ON THESE.
WE STARTED THIS YEAR WITH 356 APPLICATIONS,
AND THAT HAD TO BE FUNNELED DOWN TO 19,
AND 19 PRACTICES WERE ALLOWED TO PRESENT.
THEY GIVE A TWO-MINUTE PITCH VIDEO,
AND THEN THE SHARKS, THE NETWORK DIRECTORS OR
THE FACILITY DIRECTORS, WILL BID ON THESE PROJECTS,
AND THEY'LL BID USING THEIR FACILITY RESOURCES.
SO MAYBE IT'S A FULL-TIME EQUIVALENT OR
A FACULTY SUPPORT,
OR MAYBE IT'S MONEY OR RESOURCES TO SUPPORT
THIS INITIATIVE,
AND SO FROM THERE, 10 ARE SELECTED TO BE IN THE GOLD
STATUS FELLOWS OR IMPLEMENTING FELLOWS.
WE JUST FINISHED OUR SUMMIT A COUPLE OF WEEKS AGO UP HERE
IN WASHINGTON, D.C.,
AND THAT'S WHERE WE BRING THESE GOLD STATUS FELLOWS
AND THESE IMPLEMENTING FELLOWS TOGETHER,
AND RIGHT NOW, THOSE IMPLEMENTING FELLOWS ARE BACK
AT THEIR FACILITIES.
THEY'RE WORKING ON IMPLEMENTING THESE
PROMISING PRACTICES,
AND IT WAS REALLY JUST AN AMAZING EXPERIENCE TO SEE THE
BREADTH OF THE INITIATIVES ARE, YOU KNOW, AIMED
AT SUICIDE REDUCTION OR OPIATE SAFETY, NEW MODELS OF CARE
FOR HOME-BASED PRIMARY CARE AND REDUCING READMISSIONS,
AND THE EXCITEMENT AND THE PASSION THAT THE FRONTLINE
BRINGS TO REALLY IMPROVING THE VETERAN EXPERIENCE IS JUST
INFECTIOUS TO BE AROUND.
YOU KNOW, I'M EXCITED TO HEAR FROM ELLINA TODAY.
IN JUST OUR BRIEF DISCUSSION EARLIER, YOU REALLY CAN TELL
HOW POWERFUL THIS INITIATIVE IS.
JACOB: ABSOLUTELY, AND, ELLINA, AS A DIFFUSION
OF EXCELLENCE FINALIST, TELL US
ABOUT YOUR EXPERIENCE WITH THE PROGRAM AND WHAT YOUR PROGRAM
ACTUALLY WAS.
ELLINA: YEAH, THANKS, AND I JUST HAVE TO SAY
THANKS TO BOTH RYAN AND JACOB FOR HAVING ME HERE.
IT'S A TESTAMENT TO THE OPPORTUNITIES THAT I'VE BEEN
GIVEN THROUGH BEING IN THE DIFFUSION OF EXCELLENCE I
WOULD HAVE NEVER HAD AS FRONTLINE EMPLOYEE
IN ANOTHER WAY, SO MY EXPERIENCE.
I'M A FRONTLINE EMPLOYEE AT THE MADISON VA.
I SEE PATIENTS IN CLINIC AS A PHARMACIST PROVIDER.
ONCE PATIENTS ARE DIAGNOSED, PHARMACIST PROVIDERS CAN TAKE
THEM OVER.
SO WE SEE THINGS LIKE DIABETES AND BLOOD PRESSURE,
CHOLESTEROL, HYPOTHYROIDISM, OSTEOPOROSIS, ANYTHING THAT'S
CHRONIC THAT HAS MEDICATIONS AS THE PRIMARY THERAPY WE CAN
TAKE OVER,
AND SO AS A VETERAN CARE PROVIDER WHEN THE CALL-OUT
FOR THE "SHARK TANK" FIRST CAME, I THOUGHT, "WELL, YOU
"KNOW, WE'VE BEEN ABLE TO SHOW THE IMPACT OF PHARMACIST
"PROVIDERS SHIFT THOSE APPOINTMENTS OFF OF PRIMARY
"CARE PROVIDERS AND ON TO PHARMACISTS AND SHOW THAT IT
"OPENED ACCESS BY 27% AND REALLY TOOK OUR WAIT TIMES DOWN
"FROM GREATER THAN 30 DAYS DOWN TO TWO DAYS
FOR OUR PATIENTS."
SO WE HAD ACTUALLY HAD THAT WRITTEN UP AS JUST A PROJECT
WE HAD DONE,
AND SO IT WAS VERY EASY FOR ME TO COPY-PASTE AND SUBMIT THAT
TO THE "SHARK TANK," AND THEN AS RYAN WAS TALKING
ABOUT THE "SHARK TANK," IT REALLY MAKES ME REMINISCE
ABOUT MY TIME COMPETING IN THE "SHARK TANK" AS PART
OF THE FIRST COHORT.
AND OUR FIRST CALL-OUT, IT WAS QUITE INTERESTING BECAUSE WHEN
THE E-MAIL CAME TO SUBMIT THE STRONG PRACTICES, THAT WAS THE
FIRST TIME THAT I'D EVER BEEN EXPOSED TO THIS WAY OF DOING
BUSINESS IN THE VA,
AND I REMEMBER THINKING, "WHEN DID THE VA DECIDE TO TRY
TO BE FUN?"
WAS REALLY MY EXPERIENCE AND MY SORT OF INTERPRETATION
OF THE PROGRAM.
ANYWAY, SUBMITTED IT AND REALLY FORGOT ABOUT IT,
AND A FEW WEEKS LATER, GOT AN E-MAIL THAT
SAID, "CONGRATULATIONS.
YOU'VE MADE IT TO THE TOP 40," AND I THOUGHT,
"OF WHAT?"
I REALLY DIDN'T REMEMBER SUBMITTING ANYTHING,
AND I ACTUALLY ALMOST DELETED THE E-MAIL UNTIL I SAW
AT THE BOTTOM IT WAS SIGNED BY DR. SHULKIN,
AND I THOUGHT, "WELL, MAYBE I SHOULD TAKE A SECOND AND READ
THROUGH THIS."
AND THEN IT WAS A COUPLE WEEKS OF WHIRLWIND COMPETITION.
WE HAD A TELEPHONE INTERVIEW AND A VIDEO PITCH,
AND AGAIN, SO DIFFERENT THE SPEED AT
WHICH THIS WAS OPERATING THAN
ANYTHING THAT I HAD EXPERIENCED IN VA BEFORE.
IT WAS SO MUCH FASTER THAN ANY SORT OF CHANGE THAT HAD
HAPPENED BEFORE,
AND THEN AS I'M SITTING IN THE BASEMENT OF MY HOSPITAL AFTER
WE MADE IT TO THE "SHARK TANK"--
AND JUST LIKE RYAN WAS SAYING, IT'S MEDICAL CENTER DIRECTORS,
VISN DIRECTORS, LEADERS IN VACO THAT ARE ON THE LINE,
AND YOU'RE OVER ADOBE CONNECT,
AND YOU'VE GOT 3 SLIDES AND 2 MINUTES TO GIVE YOUR PITCH,
TRY TO CONVINCE PEOPLE THIS IS WORTH IMPLEMENTING
AT ANOTHER VA.
AND AFTER A COUPLE MINUTES, GAVE MY PITCH, WAS WAITING.
NOTHING WAS COMING THROUGH.
I WAS HOPING, HOPING, AND THEN FINALLY,
SOME BIDS STARTED COMING,
AND WE GOT SOME BIDS FROM THE EL PASO DIRECTOR
AT THE EL PASO VA AND WAS PAIRED WITH THEM TO IMPLEMENT
AT THEIR SITE.
ENDED UP GOING TO EL PASO VA TWICE BEFORE WE WERE SELECTED
FOR NATIONAL ROLL-OUT,
AND WE'VE SINCE BEEN TO 8 MORE SITES AND HAVE 20 MORE
SITES SLATED FOR FISCAL YEAR '18.
JACOB: IT'S EXCITING JUST TO BE PART OF THE INITIAL
APPLICATION PROCESS AND TO BECOME A FINALIST.
WHAT DO YOU THINK IS THE BIGGEST BENEFIT TO VETERANS
FROM THAT PROGRAM?
ELLINA: I THINK IT'S TWO-FOLD.
ONE BEING INCREASED ACCESS.
THAT'S THE PRIMARY PIECE.
IMPROVED VETERAN SATISFACTION, GOING ALONG WITH THAT, FROM
GETTING IN TO BE SEEN.
WE'VE HAD PATIENTS COME BACK AND SAY THAT THIS IS SO MUCH
BETTER THAN PUTTING UP WITH NORMAL DELAYS.
I HAD ONE PATIENT TELL ME I WAS THEIR TOBACCO ANGEL
BECAUSE I'D HELPED THEM QUIT SMOKING,
AND WE'VE ALSO SEEN IMPROVEMENTS IN QUALITY
OUTCOMES, AS WELL, RYAN MENTIONED THIS EARLIER.
SO WE'VE BEEN ABLE TO SHOW IMPROVEMENTS IN A1Cs GREATER
THAN 9% GOING DOWN, BLOOD PRESSURES ABOVE GOAL, PATIENTS
WITH CARDIAC HISTORY NOT ON STATINS AND NOW ARE,
AND SO WE'VE BEEN ABLE TO NOT ONLY SEE INCREASED ACCESS
FOR VETERANS, BUT THEY'VE ALSO BEEN HAPPY
AND HAVE BEEN GETTING BETTER CLINICAL OUTCOMES, AS WELL.
JACOB: PERFECT, AND SO CONGRATULATIONS.
IT'S AN AMAZING PROJECT BUT ONE THAT CONTINUES THROUGH
THIS PROGRAM,
AND SO WHAT WOULD YOU TELL A VA EMPLOYEE THAT HAS A BEST
PRACTICE OR AN IDEA THAT MAY BE INTERESTED
IN PARTICIPATING?
WHAT ADVICE WOULD YOU GIVE TO THEM,
AND, RYAN, WE'LL START WITH YOU.
RYAN: YEAH. THAT'S A GREAT QUESTION.
SO I THINK ONE OF THE BIGGEST CHALLENGES WE'VE SEEN
IN HEALTH CARE IS HOW DO IDEAS AND INNOVATION SPREAD,
AND I WAS READING AN ARTICLE EARLIER ABOUT ANESTHESIA
AND ANTISEPTIC.
SO TWO DIFFERENT INNOVATIONS THAT OCCURRED YEARS AND YEARS
AND YEARS AGO.
ONE OF THEM SPREAD QUICKLY AND ADOPTED QUICKLY,
AND ONE OF THEM DIDN'T,
AND I THINK THE GIST OF WHAT WE'RE STARTING TO UNDERSTAND
IS THAT THE REASON THINGS SOMETIMES MOVE SO SLOWLY
IN HEALTH CARE IS BECAUSE WE DON'T TRY TO REALLY UNDERSTAND
WHY INDIVIDUALS ARE HAVING BARRIERS TO IMPLEMENTING, WHY
INDIVIDUALS AREN'T INTERESTED IN ADOPTING SOMETHING,
WHAT ARE THE CULTURAL NORMS AND CHALLENGES?
THIS IS DIFFERENT.
THIS IS AIMED AT ADDRESSING THOSE VERY THINGS.
THIS IS AIMED AT GOING TO THE FRONTLINE AND SAYING,
"WE RECOGNIZE THAT YOU'RE IN THE TRENCHES, YOU HAVE
"THE SOLUTIONS TO SOME OF THE BIG PROBLEMS WE HAVE,
AND WE'RE GONNA SUPPORT THAT," AND I THINK THAT MENTALITY
IS DIFFERENT.
IT'S A CULTURAL TRANSFORMATION.
IT'S REALLY HELPING US MOVE TOWARDS BEING A LEARNING
HEALTH SYSTEM AND SOME OF THE CORE TENETS
OF HIGH RELIABILITY.
SO EMPLOYEES THAT ARE INTERESTED IN GETTING
INVOLVED, I THINK WHETHER THEY JUST SUBMIT AN APPLICATION
AND NEVER FOLLOW UP OR WHETHER THEY GO ALL THE WAY TO BEING,
LIKE, ONE OF OUR SUPERSTARS ELLINA, THIS IS DIFFERENT.
THIS IS MAKING A DIFFERENCE FOR VETERANS.
IT'S CHANGING THE WAY THAT WE DELIVER CARE,
AND I THINK IT'S SOMETHING INCREDIBLY EXCITING TO BE
A PART OF, SO I WOULD ENCOURAGE THEM TO
GET INVOLVED ANY WAY THEY CAN.
WE HAVE DIFFUSION LEADS IN EACH VISN.
THEY CAN CONTACT MYSELF, THEY CAN CONTACT SOME
OF THE GOLD STATUS FELLOWS WHO ARE AROUND AND TAKE PART IN THIS
BECAUSE I THINK WE'RE SEEING THE IMPACT IT'S HAVING,
AND I THINK IT'S SOMETHING THAT IN YEARS TO COME WE'RE
GONNA LOOK BACK AND ALL BE VERY PROUD OF.
JACOB: HMM. THAT'S FANTASTIC,
AND, ELLINA, FROM YOUR PERSPECTIVE, WHAT ADVICE WOULD
YOU GIVE TO A VA EMPLOYEE?
ELLINA: YEAH. I'M PROUD ALREADY.
I MEAN, I THINK THAT EVERYTHING RYAN IS SAYING IS
SO INCREDIBLY GENUINE, AND IT'S TRULY SUPPORTED.
THIS HAS BEEN AN OPPORTUNITY THAT AS A FRONTLINE STAFF
EMPLOYEE NOT ONLY IS THERE RECOGNITION FOR BEING ABLE TO
IMPLEMENT A PROJECT AND TRACK THE OUTCOMES TO IMPROVE
VETERAN CARE,
BUT IT'S ALSO TRULY SUPPORTED BY RESOURCES AND FACILITATING
IMPLEMENTATION HELP WITH FACILITATING IN EL PASO.
IT WASN'T JUST ME GOING BY MYSELF.
THERE WAS ANOTHER PERSON FROM THE DIFFUSION OF EXCELLENCE
TEAM THAT CAME,
AND SHE HELPED THROUGHOUT THE 6-MONTH PROCESS
OF IMPLEMENTING IN EL PASO,
AND THEN WE GOT A GRANT THROUGH THE DIFFUSION
OF EXCELLENCE PROGRAM TO CONTINUE TO GO TO THESE
OTHER SITES.
SO IT'S REALLY, I THINK,
SO IMPORTANT FOR FRONTLINE STAFF TO SEE THAT IT'S REAL,
THAT IT'S GENUINE,
AND THAT WE ALL HAVE A RESPONSIBILITY TO SUBMIT THESE
PROJECTS AND THESE PRACTICES BECAUSE ULTIMATELY IT'S
ABOUT IMPROVING VETERAN CARE.
AND IT STARTS REALLY AT THE TOP.
I MEAN, DR. SHULKIN, WHO IS OF COURSE NOW OUR SECRETARY, THIS
WAS ONE OF HIS MAIN INITIATIVES
AS UNDER SECRETARY,
AND HE HAS BEEN A STARK ADVOCATE FOR OUR FRONTLINE
STAFF THROUGHOUT THIS PROJECT AND BEYOND SINCE THAT TIME.
I MEAN, THAT'S WHERE I FIRST MET JACOB.
HE AND LATRICE AND DR. SHULKIN CAME TO WISCONSIN LAST YEAR.
HE WAS THE KEYNOTE SPEAKER AT THE PHARMACY SOCIETY
OF WISCONSIN MEETING.
HE ACTUALLY--FUN FACT.
HE TOLD ME HIS GRANDFATHER WAS THE VERY FIRST PHARMACIST TO
EVER PRACTICE AT THE MADISON VA.
SO IT WAS KIND OF A NEAT CONNECTION THERE,
BUT HE'S JUST BEEN SO SUPPORTIVE AND WILL ADVOCATE
FOR ANY FRONTLINE STAFF THAT ARE MAKING A DIFFERENCE TO
HELP IMPROVE VETERAN CARE.
JACOB: WELL, I WANT TO THANK YOU BOTH FOR TAKING THE TIME
TO TALK WITH US TODAY AND ALSO TO OUR VA EMPLOYEES THAT WE
NEED YOUR IDEAS AND YOUR INNOVATION,
AND IF YOU WANT TO PARTICIPATE, DEFINITELY LEARN
MORE ABOUT THE DIFFUSION OF EXCELLENCE PROGRAM, GET
INVOLVED AT YOUR FACILITY.
AGAIN, WANT TO THANK YOU FOR WATCHING TODAY.
JOIN US FOR OUR NEXT EDITION OF "VHA EXCELLENCE
IN HEALTH CARE."
THANK YOU VERY MUCH.
ANNOUNCER: JOIN US FOR OUR NEXT EDITION OF
"VHA EXCELLENCE IN HEALTH CARE" WHEN OUR TOPIC WILL BE
"EXCELLENCE AND INTEGRITY."
"VHA EXCELLENCE IN HEALTH CARE" IS PRODUCED BY THE U.S.
DEPARTMENT OF VETERANS AFFAIRS.