Dr. Ryan Vega explains how the VHA’s Innovator’s Network (iNET) is transforming how the VA identifies, incubates, and deliver healthcare innovation to improve healthcare for veterans.
Innovation is the bud from which all things radical seem to bloom. It’s also the critical element at the center of the Veterans Health Administration (VHA) objectives to improve the quality and reach of healthcare for its veterans. Changes spurred by the Mission Act—which hopes to create greater access through telehealth services, among other approaches—is just one example of how the VHA is embracing innovation. However, there is more.
The VHA Innovator’s Network ‘s (iNET’s ) objective is to identify, incubate, and to spread innovations throughout its organization; it’s one of the many developments that has come from the VHA’s Innovation program since its development in 2009. The VHA Innovation Ecosystem is a relatively new construct that has evolved through the combination of several small VA sites across the country. It’s working with a network of innovation specialists and private sector partners to identify the most promising innovations, fund them, and spread them to benefit veterans.
As opposed to many bureaucratic institutions, the Innovation Ecosystem is heavily driven by bottom-up initiatives and seeks to foster individuals (doctors, nurses, program managers) who are pursuing healthcare improvements that may help veterans. It allows employees to submit their ideas and receive funding to design, develop, test, and spread innovative concepts.
To find out more about iNET, we asked Dr. Ryan Vega, Executive Director for VHA Innovation Ecosystem to explain how the program operates, what challenges it’s up against, and how it plans to foster the desire to create solutions to help the specific needs of U.S. veterans:
HITC: I know that you have been quite successful with integrating innovation to lead to best practices for the VHA, spearheading the Diffusion model. You were also honored with an IT-innovator of the Year Award as part of the 2018 Pinnacle Awards. With that in mind, what has been your innovation strategy that has led the VHA’s success in improving many facets of how it functions?
Dr. Vega: Thank you, it’s been an honor to have a role in helping to overcome some unique challenges and identifying potential solutions to usher in a new era of innovation across VHA. VA and VHA’s Innovation Ecosystem are committed to transforming care and experience through innovation because our nation’s veterans deserve the best possible care. It has been my privilege to serve in this mission.
The core purpose of the VHA Innovation Ecosystem is to catalyze, enabling the discovery and spread of mission-driven, healthcare innovation. Our mission is to allow the development and spread of healthcare innovation that exceeds expectations, restore hope and builds trust with veterans through innovation. Our success can be attributed to VHA’s two greatest assets: our employees and our mission to serve our nation’s veterans. Our strategy, thus, has been simple – empower the front line and get out of the way! We have also recognized that any successful innovation strategy requires a disciplined framework as well as a careful balance of both grassroots and strategic innovation. To do this, we have deployed a phase-gate model that helps guide the maturity of innovative ideas and solutions to advance through the organization by following a structured, repeatable, outcomes-driven process. The engine driving our mission and vision are our three strategic priorities to embed innovation as a core fabric of VHA, build a collaborative innovation community, and deliver a repeatable process for scaling innovation. Another core tenant of our success, I believe, has been our team’s willingness to learn and challenge our operations continuously. For instance, we recently began adapting components of Vijay Govindarajan’s “3 Box Solution” into our overall strategy after recognizing we needed more balance to our “past, present, and future.”
HITC: It seems you have created a rather engaging environment where not only is innovation occurring (ketamine for depression, 3D printing, etc.) but it’s the “HOW” and “WHY” change is happening that’s unique. Can you expound on that idea for us?
Dr. Vega: I believe VA and innovation have been synonymous for quite some time. VA has produced some of the most impactful healthcare innovations during the past few decades, such as barcode medication administration. VA medical centers across the country have been doing fantastic work long before we came along. What lacked was a coordinated network that brought these sites together and helped provide a framework to guide innovation activities.
In 2015, the VA Innovators Network was launched and has now grown to over include over 30 VA Medical Centers across the U.S. Led by Brynn Cole and Allison Arnheim. The network is truly the lifeblood of the Innovation Ecosystem, having infused human-centered design into our core operations. I believe this has helped shape the lenses through which innovation activities occur, as well as framing the questions we ask in arriving at solutions that meet the unique needs of our Veterans. Central to the “how” and “why” is empathy: genuinely listening to the voice of the customer to understand the challenge or opportunity trying to be solved. As noted, we have made an emphasis over the last year on focusing on the “Why.”
For us, this work is about changing lives, saving lives. As I mentioned, above, one of our greatest assets is our mission – there is something powerful about mission-driven innovation.
In linking IE’s success to our strategic priorities, and as VA moves towards an HRO model, IE is creating an environment that fosters innovative approaches to solving complex problems while enabling a learning health system that allows for experimentation as well as learning from experience.
As the connective tissue of VHA’s innovation community, IE is modeling a new set of behaviors to promote a culture of continuous improvement through collaborative activity with both internal and external partners to break-down silos and deliver more. With our partners, we’re developing a replicable model for identifying and diffusing veteran-centric, best practices across the enterprise in a disciplined manner–
ensuring that we are delivering world-class care to ALL Veterans.
HITC: Following that question, how does the VHA continue to build on that strategy? Do you have an investment component to your plan? What about external program partners?
Dr. Vega: Both Innovators Network and Diffusion of Excellence, two of our core portfolios, create opportunities at the right staff level to participate in innovation activities, each at different stages of the innovation lifecycle. Innovators Network uses a venture capital model of investing in innovation through its Spark-Seed-Spread competition. This model provides a tiered level of funding to employees for ideas or solutions at various stages of development. For example, a “Spread” grant offers up to $200,000 of funding to support the spread of a product or project to other VA sites of care from the origin site.
Diffusion of Excellence conducts an all employee competition known as “VHA Shark Tank” that sources exemplary practices from the field. Hundreds of employees participate, and eventually, a small subset of finalists is invited to pitch their exemplary practices to the medical center and network directors around the country who bid resources to fund facilitated replication of these practices at their sites. This has allowed us to accelerate the spread of practices as well identify those which are best positioned to scale across the enterprise.
Concerning external program partners, we feel they are vital to the success of the Ecosystem. All the projects in our strategic portfolio have, and in all honestly rely on, partnerships with industry and academic affiliates. Our partnerships help to accelerate innovation through MOUs and CRADAs. In partnering with academia on hackathons, we are identifying novel clinical solutions for Veterans, and industry partners, such as GE Healthcare, Verily, and AVIA, are helping us transform the way VA delivers care. Through our partnerships, we can provide more together.
HITC: Can you tell us more about the Diffusion Model? What was the primary concept, how has it played out, and what are the most significant improvements you have seen thus far?
Dr. Vega: The primary concept was to design and implement a model that accelerated the identification and spread of best practices across the health system. Scaling innovation and best practices – and perhaps more importantly, sustaining these practices – remains a challenge for healthcare writ large. The model consists of a five-step, repeatable process that begins with identifying exemplary practices from the field through the VHA Shark Tank competition.
The top practices selected, internally referred to as Gold Status Practices, undergo facilitated replication with a focus on accessing real-world impact as well as scalability across the enterprise. We will select our 5th cohort of Gold Status practices at our Innovation Experience event in October and have been taken back by the success of the imitative thus far. To date, we have seen 47 methods replicated over 400 times and are currently scaling five best practices across the country, including Project HAPPEN which focuses on reducing non-ventilator associated hospital-acquired pneumonia and is projected to have saved dozens of lives!
HITC: What do you think has led you to create the right culture and synergy required to make the kind of impact that you are at the VHA. What’s the recipe for creating an environment of innovation like this, and do you think other organizations would benefit from doing the same?
Dr. Vega: Access to talent and leadership support are critical. We are fortunate to have such a talented workforce and field leadership that the infrastructure for this work has been in existence for quite some time. With a diverse portfolio of both clinical and IT innovations, we have a deep bench of in-house talent with expertise in driving projects across the innovation lifecycle.
Our talent is well versed in acquisitions and project management, concept development and prototyping, piloting, and national diffusion. We also provide and leverage tools, such as Future Technology Lab and SimLEARN, that offer a safe harbor environment for innovation development and testing.
I mentioned leadership. I am always taken back at the leadership support and innovation work occurring at medical centers across our health system. It is hard to overestimate the impact leadership has over creating the right culture for innovation to thrive. Employees need to feel empowered as well as safe to take a risk, knowing they are provided some guardrails to help guide them along the way.
Over the past few years, we have focused on five core principles we believe are necessary to build and sustain an innovative culture: (1) Empower the front line (2) Exercise the Innovation Muscle (3) Design to Fail Forward, Scale Big (4) Build Collaborations and Connections (5) Celebrate the Small Wins. If I had to choose one or two ingredients that have been crucial to advancing our innovation culture, it would be empathy and empowerment. Any organization working to build or develop an innovation culture that focuses on these two core tenets will benefit tremendously as we have seen.
HITC: We have talked about some of the successes, but what about the challenges? What have been the biggest hurdles you’ve had to face as you strive to improve care for veterans?
Dr. Vega: The two biggest challenges we continue to see is sustaining the culture of innovation and shortening the time it takes to scale innovation. I suspect these are unlikely to change for some time given they have been challenges in healthcare, and other industries, for a while. Healthcare is dynamic and complex, and there are always competing priorities. Sustaining this work requires dedication and resiliency. However, for every challenge, we also see an opportunity.
Earlier I mentioned the phase-gate model. This model provides a data-driven mechanism to map and track each innovation’s progress and allows for a common language across the VHA Innovation Community. Use of the model standardizes the way an idea moves through the different phases of the innovation, providing transparency throughout the process. This promotes trust as well as better collaboration and understanding of what each stakeholder brings to the table. Establishing a common language and developing trust are examples of drivers that are starting to create and sustain an innovation culture at VHA.
HITC: What do you think has been the most significant benefit to veterans since pioneering these efforts? Can you share with us the organizational milestones and achievements that make you proud?
Dr. Vega: We measure success in the number of lives changed, impacted, and in many cases, saved. Any innovative idea or solution that has made a difference in even one Veteran’s life is a significant accomplishment to us.
We also recognize the importance of innovation that directly improves the experience of our workforce. LEAF (Light Electronic Action Framework), is allowing employees to digitalize and standardize administrative processes and driving impressive gains in efficiency and has won recognition for its impact.
The organizational milestones that stand out are the projects that have started as ideas and are now scaling across the enterprise directly impacting the lives of Veterans Machine Intelligence (MI) is another excellent example and is the future of health care. The Ecosystem wants to galvanize the academic and commercial worlds in support of solutions that are innovative, scalable, and able to integrate into the downstream clinical workflow. These solutions will benefit both Active Duty Military and Veterans in support of the longitudinal health record.
HITC: Let’s talk about the future: are there any special projects in the works or long-term objectives you can share with us?
Dr. Vega: There are several projects in our strategic portfolio we are excited about including 3D printing, Virtual Reality for clinical care delivery, as well as precision medicine. Our newly formed office resides in Office of Discovery, Education and Affiliate Networks under Dr. Carolyn Clancy, joining us with the Office of Research and Development (ORD) as well Office of Academic Affiliations (OAA). This unique synergy holds tremendous potential, and we are working with our colleagues in OAA to develop an advanced fellowship in healthcare innovation leadership. We are closely working with our colleagues in ORD on several fronts, such as advancing the use of artificial intelligence or machine intelligence.
HITC: Are there any technologies on the horizon you can see playing a vital role in the future of the VHA?
Dr. Vega: Several – the evolving uses of 3D printing will only continue to grow and will be relevant to our strategic direction. We are working with several federal and commercial partners to expand workaround utilizing virtual reality for care delivery as well as the use of Artificial Intelligence in clinical decision support.
I also believe Veteran-facing technology will play a significant role in our future as being able to meet the Veteran in the environment of their choosing will be necessary.
HITC: What’s the ultimate goal that you hope to achieve during your tenure in this position? What’s the lasting impact you hope your innovation efforts will make?
Dr. Vega: The goal is to have a lasting, positive impact on the lives of veterans, caregivers, and those that serve them, including our workforce. We hope the work we are doing today results in a stronger, more independent operating Ecosystem tomorrow, and innovation becomes imbedded into our daily work.