VA uses Web to share best practice lessons
Web site hot-links innovations to users
Some years ago, one of the Department of Veterans Affairs’ (VA) 173 hospitals was cited by a service organization for having too much loose filing that needed to go into the medical record. The hospital agreed to fix the problem and made an honest effort to do so. But three years later, a follow-up review revealed that the amount of loose filing at the hospital had actually increased.
Thomas L. Garthwaite, MD, acting undersecretary for health for the VA, noticed the problem, concluding that "there’s something not quite right when you ask a group of people to solve a problem and it results in the problem getting worse," says Nancy A. Thompson, PhD, FACHE, associate director with the Veterans Healthcare Administration (VHA) Office of Special Projects (OSP) in Washington, DC. "There had to be a better way of helping people solve their problems. It seemed likely that, with 173 medical centers across the country in the VA, someone had probably already dealt with it," Thompson says.
In fact, Garthwaite himself had worked at a medical center that had dealt with the problem of loose filing, and that information was passed along to the problem hospital.
The question became, "How do we get this kind of informal knowledge — as opposed to what you learn in courses — out of the heads of the people in the file room of one hospital where they knew how to solve this problem, over to the other side of the country, where they were still struggling?" Thompson says. "And the answer was, you can’t; you’ve got to have some kind of a structure in place."
At that time, the VA had no systematic structure for sharing informal knowledge. To gather such information, staff had to "get on e-mail, get on the phone, contact all their buddies, or go out to some news group and solicit ideas," Thompson says. That approach had two significant problems. First, it required the staff member to spend a lot of time soliciting input. Second, and perhaps more importantly, it forced the staff member to admit to colleagues that he or she didn’t know something.
"There’s fear," Thompson says. "I don’t think the VA’s unique in that. People are a little afraid to admit they don’t know something. And it’s scary to go up to all your colleagues and say, I don’t know how to fix this problem at my facility; have any of you fixed it?’"
To resolve the problem, Garthwaite charged the VHA’s OSP in summer 1997 with creating a systematic mechanism to share informal knowledge throughout the system where there would be no threat for people interested in seeking information on how others had solved certain problems or addressed certain issues. "The bottom-line goal is that, when somebody has an innovative idea, it spreads like wildfire throughout the system and gets tweaked and adapted and adopted to meet the individual hospital’s needs," Thompson says.
In October 1997, under the direction of Victor S. Wahby, MD, director, the OSP awarded a small contract to a Web design company, and on Dec. 8, 1997, it launched the first intranet version of the Virtual Learning Center. "This has evolved and grown immensely [since then]," Thompson says. "There have been many new features added to it, and, in June 1999, we went live on the Internet. So now the whole health care community throughout the world can share their innovations and best practices that have worked for them."
No longer exclusive to the VA, the Virtual Learning Center (www.va.gov/vlc) is now available free of charge to anyone who works in health care. "That can be administrative, clinical, a support function, direct hands-on patient care — any of the functions of a health care environment," Thompson says. "People can go in and upload their innovations and ideas and share them," she says.
To date, more than 700 "lessons" have been posted on the Virtual Learning Center site by health care professionals working within as well as outside the VA system. Each lesson contains the following information:
• author demographics;
• title;
• core message;
• rationale/need;
• actions taken;
• results;
• lessons learned;
• contact person demographics;
• up to five key words on which the lesson can be searched.
In addition to simply browsing through the site’s 700 lessons, users can also take advantage of the Virtual Learning Center’s personal profile option, which allows them to receive e-mail notifying them that lessons in their areas of interest have been posted. "With the personal profile feature, you do a one-time entry of your demographics with your e-mail address on it," Thompson says. "You submit that and select the key words you are interested in. There are 130 or 140 key words in there, and you can pick as many as you’d like. From then on, any time someone submits a new innovation with one of your key words in it, you get a one-liner in your e-mail with a hot link." This feature has been very popular with the many VA employees who have both submitted and used innovations on the VLC.
Thompson notes that hospitals and integrated delivery systems outside the VA are welcome to use the Virtual Learning Center as a means of sharing innovations within their organizations. Simply instruct staff to insert the initials of your medical center at the front of any submission. "That will clump them all together in the alphabetical listing," Thompson says. Then, by using the browse function, staff can immediately gain access to all the lessons posted by their own facility. (For information on setting up your own knowledge-sharing site, see related article, below.)
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