VISN 1 Strategic Plan 2009-2013

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VISN 1 Strategic Plan 2009-2013 Powered By Docstoc
					                      VISN 1 STRATEGIC PLAN 2009-2013

Goal I: Excellence in Quality and Safety                             Lead
Objective 1.1: Build Culture of Improvement                          PIC
Goal II: Excellence in Access and Service
Objective 2.1: Develop Systematic Approach to Location of Services   SPC
Across VISN 1
Objective 2.2: Enhance Systems for Veteran-Staff Communication       CSC
Goal III: Excellence in Work Force
Objective 3.1: Streamline Recruitment and Hiring                     HRC
Objective 3.2: Improve Clinical Informatics and IT support           IDMC
Goal IV: Excellence in Financial Stewardship
Objective 4.1: Relentlessly Reduce Waste and Improve Efficiency to   ALC
add value                                                            (with CLC)
Objective 4.2: Ensure Robust Revenue Stream to Support               NRC
Organizational Goals
Goal V: Excellence in Service to Our Communities
Objective 5.1: Develop Research Strategic Plan                       CLC




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Goal I: Excellence in Quality and Safety
Objective 1.1 Build a culture of improvement.

The VA New England Healthcare System intends to improve quality, safety and value for
veterans and other stakeholders by accelerating the pace of clinical and support service
improvements. We will clarify and communicate a deep commitment to continuous
improvement, expand improvement capabilities, apply the most effective methods
available and make improvement an integral part of everyday work for all staff.

What do we want to look like in 3-5 years?

At the individual staff and work unit level:
Every employee and work unit is actively engaged in improving their work: “Improving
our work is our work.”
Staff and work units have integrated improvement into their work and have time for
improvement work
Staff and work units are provided opportunities to learn improvement skills
Staff and work units have available specialized resources to assist in successful
improvement efforts, including individuals with specialized improvement expertise
(improvement professionals), assistance with obtaining and analyzing data, and
facilitators.
Staff and work units will share their improvement work and learn from others within and
outside their local organization
Managers participate in, support and lead improvement activities

At the medical center and service level:
There is a systematic, effective and fully deployed program for organizational
improvement
The program consists of standardized systematic elements which are explicit and undergo
continuous improvement
Improvement activities are aligned with strategic priorities
Improvement activities that cross individual work units and services are actively
supported by leaders; work is done within a system rather than within silos.
Staff and work units will share their improvement work and learn from others within and
outside their local organization
Local leaders model improvement methods, improve their own work; they mentor and
support improvement projects and quality in daily work

At the network level:
There is a systematic, effective and fully deployed program for organizational
improvement
The program consists of standardized elements which are explicit and undergo
continuous improvement
Improvement activities are aligned with strategic priorities
Improvement activities that cross medical center and service lines are actively supported
by leaders; work is done within a system rather than within silos.
Network leaders mentor, support and lead improvement projects


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Improvement infrastructure is developed and maintained including:
    training programs for front line staff/work groups, improvement professionals and
       leaders
    resources for data reporting and analysis
    resources for team facilitation and project management
    programs for sharing of successes and lessons learned across medical centers and
       service lines
Those involved in network improvement will share their improvement work and learn
from others within and outside the network

Objective 1.1: Build Culture of Improvement

Strategy   Develop improvement learning resources and activities linked to
  1.1.1    priority work
 Action    Conduct leadership learning efforts--guest experts, external site visits,
 1.1.1 a   personal learning activities
 Action    Develop and spread front-line micro-system team learning resources--
 1.1.1.b   building on Team Culture and clinical micro-system efforts
 Action    Create middle manager action learning resources
 1.1.1.c
 Action    Develop a cadre of trained facilitators and other improvement specialists
 1.1.1.d

Strategy   Initiate pilots and support innovation
  1.1.2
 Action    Initiate widespread trials of activated frontline micro-systems, starting with
 1.1.2.a   volunteers and high priority teams and inviting patient and other
           stakeholder partnership
 Action    Develop pilots of medical center/service line lean improvement projects
 1.1.2.b   (e.g. rapid process improvement workshops)
 Action    Develop a VISN innovation grants program to accelerate innovation and
 1.1.2.c   learning
 Action    Develop a proposal for a Veterans Engineering Resource Center (VERC)--
 1.1.2.d   collaboration between VISN 1 and academic engineering partners

Strategy   Promote systematic implementation as well as common language and
  1.1.3    methods
 Action    Assess and formulate medical center and service line approaches to
 1.1.3.a   improvement--build alignment and consistency over time
 Action    Create a VISN Improvement Resource Office-including a) analytic,
 1.1.3.b   industrial engineering and expert resources; b) coordination of culture of
           improvement evaluation plan; and c) communication plan for overall
           Objective
 Action    Inventory current improvement efforts and share widely via Improvement
 1.1.3.c   Summit and other means



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Metric: Develop VISN improvement infrastructure
Goal: Implement VERC, Improvement Grants Program, Activated Microsystems
development & recognition program and systematic approach to improvement events

Metric: Number of clinical and administrative workgroups completing steps to be
recognized as Activated Microsystems
Goal: 1000 Activated Microsystems

Metric: Number of improvement events
Goal: 500 over three years

Metric: Staff ratings on AES questions related to culture of improvement (OAI 5,6,11
and 16)
Goal: Be in top 15% of Networks

Metric: % Performance Measures met
Goal: 95% or be in top 3 VISNs whichever is higher

Metric: National health care metrics (HEDIS, ORYX, HCAPS etc)
Goal: Be in top 10% of health care organizations nationally and regionally




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Goal II: Excellence in Access and Service
Objective 2.1 Develop systematic approach to location of services across VISN

The VA New England Healthcare System will develop and implement a systematic
approach to the location of health care services across the Network so as to provide
excellent access and better achieve our mission of providing patient-centered care to the
veteran population of New England.

What do we want to look like in 3-5 years?

The Network will have developed criteria and standards for the location of services
across the network. These criteria will
     Be based on thoughtful analysis of data
     Support improved quality of patient care
     Support improved patient safety
     Support cost effective use of resources
     Be consistent with national policy and planning procedures
     Have the support of leadership and key stakeholders
     Include targets for geographical access (% of population within specific drive
        time) for the full spectrum of services
Network will have demonstrated steady progress in implementing criteria and standards.

Strategies and Actions

Objective 2.1:     Develop Systematic Approach to Location of Services across VISN 1.

  Strategy    Criteria for location of specific services or bundles of services will be
    2.1.1     developed using systematic methodology.

   Action     A task force will be formed by Strategic Planning committee to develop the
   2.1.1.a    criteria.
  Strategy    Network will implement changes to progressively meet criteria and
    2.1.2     standards
   Action     An inventory of services will be developed and maintained.
   2.1.2.a
   Action     A gap analysis of current services compared to the criteria will be performed.
   2.1.2.b
   Action     Actions to better align services with criteria will be identified and
   2.1.2.c    implemented on an ongoing basis.

Metric: Presence of Network criteria and process
Target: Network will have established criteria for location of full range of services and
established process for instituting clinical services at a given site.

Metric: Geographical Access, using National (and where National criteria are absent)
Network developed, criteria and standards



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Target: Significant improvement will be demonstrated in geographical access across the
network. Specific targets will be determined after criteria and gaps identified.




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Goal II: Excellence in Access and Service
Objective 2.2: Enhance systems for veteran-staff communication
V 2.0 1/22/09

The VA New England Healthcare System will create and support effective and efficient
systems for communication between veterans/families and VA staff. These systems will
cover both clinical and administrative contacts, incorporate veteran preferences and
provide a high quality communication experience for veterans/families and staff
members.

What do we want to look like in 3-5 years?

    Successfully shift the culture to one that recognizes that quality communication is
     inseparable from quality healthcare
    Patients and families will know or can easily determine how to contact VA New
     England staff for clinical and administrative needs
    Calls are answered timely and courteously
    Most issues are resolved at the initial point of contact without need for transfer or
     call back
    Systems for electronic communication via Secure Messaging Systems in My
     Health E Vet are fully implemented and perform well
    All facilities and services can monitor telephone and SMS customer service
     statistics (call hold times, drop rates, etc)
    There is a systematic, effective and fully deployed program for customer service
     training and service recovery related to communication


Objective 2.2: Enhance Systems for Veteran-Staff Communication

Strategy   Develop effective knowledgeable communication centers
  2.2.1
 Action    Establish a VISN 1 design team – seek out knowledgeable successful subject
 2.2.1.a   matter experts from within and outside VA to provide guidance for all
           necessary resources (e.g. staffing, software/hardware) required to establish a
           call center
 Action    Prepare appropriate Requirement Analysis and Cost Benefit Analysis
 2.2.1.b   documents for the securing of funds to ensure appropriate staffing and state
           of the art equipment
 Action    Standardize concise phone tree – provide appropriate tools and education to
 2.2.1.c   staff to achieve goal of minimizing hand-offs

Strategy   Staff and veteran education and training
  2.2.2
 Action    Implement a communication – specific standardized training program for all
2.2.2.a    staff
 Action    Establish team to develop front-line scripts for specific program areas to


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 2.2.2.b   enhance quality and patient satisfaction – include staff training to support
           appropriate level of service
 Action    Utilize Education departments to create course work and schedule for
 2.2.2.c   training classes

Strategy   Validate contact information
  2.2.3
 Action    Develop effective inventories of phone/email contact information for
 2.2.3.a   publication to our veterans so they know how to contact us (e.g. webpage,
           handouts, magnets, etc.)
 Action    VISN-wide campaign to improve patient contact information
 2.2.3.b

Strategy   My HealtheVet – Implement secure messaging VISN-wide
  2.2.4
 Action    Expand current efforts of facility MHV Points of Contact to include Primary
 2.2.4.a   Care Clinical Champions and Chief Health Information Officer – design
           VISN-wide implementation plan
 Action    Develop plan to make In-Person Authentication (IPA) process available at
 2.2.4.b   every site of care at point of contact
 Action    MHV Vet and IPA Enrollment Campaign – MHV mailings, flyers, posters,
 2.2.4.c   facility MHV training rooms
 Action    Develop business rules for secured “email” response and escalation process
 2.2.4.d

Strategy   Develop monitoring for system and staff performance and customer
  2.2.5    satisfaction
 Action    Monitor the deployment (e.g. installation and training) of required
 2.2.5.a   software/hardware to each clinic area in order to capture statistics
 Action    Develop standard communication performance measures (e.g. turnaround
 2.2.5.b   times, transferred calls, etc.) Collect, assess and publish monthly call center
           statistics through a standardized process
 Action    Assess and monitor secure messaging stats including effectiveness of
 2.2.5.c   business rules and impact on clinician time (e.g. does time required to return
           calls decrease?)
 Action    Monitor the MHV IPA stats at each facility (% of active patients who are
 2.2.5.d   IPA’d) – determine areas for improvement
 Action    Incorporate communication measures into facility Quadrad performance
 2.2.5.e   plans, pay for performance agreements, VISN x-mas tree and other
           measurement systems
 Action    Include ghost calls into “Fresh Eyes” Program
 2.2.5.f

Metric: Patient satisfaction with telephone and communication questions on SHEP
Target: VISN be in top 25% of VISNs




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Metric: Ability to monitor telephone service
Target: All clinical services will be supported by telephone response systems that are
actively monitored.

Metric: Telephone call center performance
Target: All medical centers be at benchmark performance as specified in VHA directive
on telephone service, specifically average speed of answer by a live person within 30
seconds and abandonment rate of under 5%

Metric: Use of secure messaging systems
Target: Easy enrollment into SMS will be available to patients at all sites of care
Target: All providers in the network will be utilizing Secure Messaging Systems




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Goal III: Excellence in Work Force
Objective 3.1: Streamline Recruitment and Hiring

The VA New England Healthcare System will develop and implement recruitment and
hiring processes that are efficient, effective, user friendly and promote the VA as a leader
in healthcare.

What do we want to look like in 3-5 years?

The VA New England Healthcare System will have developed streamlined, timely
recruiting and hiring processes.

    The processes are timely, getting people on board quickly so as not to have gaps
     in service or patient care.
    HR Staff are engaged with the process, users, and customers and are continually
     improving processes.
    Applicants and VA staff find the system user friendly – flexible, personal and
     responsive to individual needs.
    Service customers are partnering with HR and are satisfied with the system.
    Processes are transparent and managers find the system easy to navigate.
    Processes are efficient and standardized and using resources wisely.
    VA hires high quality staff, getting the best person for each position.
    The recruitment process puts VA in a favorable light.
    The process is flexible and adapts to the changing needs of the organization.

Objective 3.1: Streamline Recruitment and Hiring

Strategy    Develop a service partnership between HR staff and service customers to
  3.1.1     promote an engaged work force.
 Action     Assess HR staff competencies.
 3.1.1.a
 Action     Provide training to HR staff on process improvement.
 3.1.1.b
 Action     Implement efforts and changes to help non-HR services to become engaged
 3.1.1.c    partners in the process.

Strategy    Improve the recruitment process.
  3.1.2
 Action     VISN 1 will participate in the national recruitment pilot.
 3.1.2.a
 Action     Implement initiatives to ensure HR across the Network is consistently
 3.1.2.b    utilizing the latest recruiting technology and tools.
 Action     Work with HR nationally and OIT to make the gateway from VA careers
 3.1.2.c    website to USAJobs website user friendly for applicants and managers.
 Action     Develop tools to assist in the creation of job analysis and benchmarks that
 3.1.2.d    result in better applicant screening methodology.
Strategy    Improve the hiring process.


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  3.1.3
 Action     Focused systems redesign initiatives will be implemented at each facility
 3.1.3.a    (LEAN thinking).
 Action     Implement a computerized system for the hiring process.
 3.1.3.b

Strategy    Improve current processes through standardized and timely systems.
  3.1.4
 Action     Centralize classification work.
 3.1.4.a
 Action     Hire dedicated classifiers.
 3.1.4.b
 Action     Define scope of work that the classification unit will be involved in.
 3.1.4.c
 Action     Implement computerized systems for use in the classification process. .
 3.1.4.d

Strategy    Develop a system that will effectively monitor and measure hiring and
  3.1.5     recruitment activity.
 Action     Develop performance metrics for HR (Dashboard).
 3.1.5.a
 Action     Create a useful automated tracking system for monitoring recruitment and
 3.1.5.b    hiring

Metric: User satisfaction with HR service support, quality & availability of candidates
and timeliness of recruitment & hiring.
Target: All medical centers average Very Good or Excellent on survey items related to
these issues

Metric: Develop measurement system for recruitment and hiring
Target: Computerized tracking system for recruitment and hiring fully implemented
across the network

Metric: Timeliness of recruitment & hiring
Target: Network will show continued improved annually, and be in top 25% of VISNs if
standardized national measures available.




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Goal III: Excellence in Work Force
Objective 3.2: Improve informatics and IT support
VISN 1 will be at the forefront of VA informatics innovation and develop a strong
collaborative relationship with VA OIT so as to use VHA IT capabilities in support of the
clinical care and support services to assure state of the art technology and quick
responsiveness to the needs of end users.

What do we want to look like in 3-5 years?

At the individual staff and work unit level
     Adequate hardware and software for staff to efficiently provide services
     Ongoing worker training to stay current in use of new and existing software
     Prompt responsiveness to problems that arise at all levels of organization

At the medical center and service level
     Availability of management tools that allow measurement at system, team and
       provider level
     Systematic processes in place to plan for and meet IT needs
     Close collaboration and synchronization of VAOI&T and facilities/service line
       goals

At the VISN level
     Data warehouse that allows VISN to assess performance in real time
     State of the art networking of data across the VISN
     Standardization of local software development across VISN
     Work with VISN leadership to develop and implement IT spend plan
     Close collaboration and synchronization of VA OI&T and VISN goals.

Strategies and Actions

Objective 3.2: Improve informatics and IT support

 Strategy     Develop VISN informatics capacity
   3.2.1
  Action      Implement VISN Informatics service as planned
  3.2.1.a
  Action      Development of data warehouse (timeline for completion of deliverables based on
  3.2.1.b     priorities of VISN and feasibility of technology)
  Action      Train managers to utilize warehouse
  3.2.1.c
  Action      Implement project management system to coordinate and track project development
  3.2.1.d     and implementation for data warehouse
 Strategy     Standardize VISN ability to develop Class III software
   3.2.2
  Action      Within constraints of national policy develop mechanisms to identify needs that
  3.2.2.a     could be addressed with Class III software and to implement such software in
              accordance with national policy


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 Strategy    Improve end users satisfaction with IT support
   3.2.3
  Action     Establish help desk at each facility
  3.2.3.a
  Action     develop and implement regular customer satisfaction survey
  3.2.3.b
  Action     Track timeliness of trouble shooting completion through REMEDY
  3.2.3.c
  Action     Develop annual local and VISN IT spend plan with input of facility and VISN
  3.2.3.d    leadership

 Strategy    Develop IT literacy
   3.2.4
  Action     Standardize training for CAC and ADPAC personnel
  3.2.4.a
  Action     Assess educational needs of staff and provide annual report to Education committee
  3.2.4.b
  Action     Support extensive training programs for staff
  3.2.4.c

Metric: Development of Informatics Capacity
Target: Network Informatics Service will be established and producing specific products
in all service lines, clinical and support

Metric: End user satisfaction with IT support and programs
Target: All medical centers average Very Good or Excellent response on survey on IT
support

Metric: End User Satisfaction with IT Training
Target: All medical centers average Very Good or Excellent on survey item on Training
and Education




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Goal IV: Excellence in Financial Stewardship
Objective 4.1: Relentlessly Reduce Waste and Improve Efficiency in order to Add
Value

The VA New England Healthcare System will relentlessly reduce waste and improve
efficiency in order to add value to the services we provide.

What do we want to look like in 3 – 5 years?
   There is a systematic, effective and fully deployed program for organizational
      improvement involving all employees that is focused on reduction of waste and
      improvement of efficiency
   Clinical activities, including outpatient visits, hospital days of care, diagnostic
      testing and therapeutic interventions, that do not add value to patient experience
      will be continuously identified and reduced.
   Administrative support activities will be provided in a highly efficient and
      effective approach
   Major programs will have standards for staffing, space utilization, productivity,
      and core processes that are continuously studied and improved

Objective 4.1: Relentlessly Reduce Waste and Improve Efficiency

Strategy    Involve all employees in active efforts to reduce waste and improve
  4.1.1     efficiency
 Action     Develop standardized training program for all employees on systems
 4.1.1.a    redesign concepts with emphasis on the reduction of waste. The program
            should include uniform language, definitions, processes and metrics.
 Action     Incorporate waste reduction and efficiency improvement in goal sharing,
 4.1.1.b    reward & recognition, innovation and micro-system improvement programs

Strategy    Promote efficiency and effectiveness in the use of clinical resources
  4.1.2     throughout the VISN.
 Action     Continue actions to reduce Pharmacy costs
 4.1.2.a
 Action     Develop and implement criteria designed to ensure the appropriateness and
 4.1.2.b    necessity of consult, lab test and imaging requests.
 Action     Implement initiative to reduce unnecessary Bed Days of Care
 4.1.2.c
 Action     Develop uniform approaches to major clinical programs will be developed
 4.1.2.c    that include standards for staffing, productivity, space utilization and
            processes that optimize value.

Strategy    Promote efficiency and effectiveness in administrative support services
  4.1.3     throughout the VISN.
 Action     Review opportunities for additional consolidation of administrative functions
 4.1.3.a    (HR, Fiscal, A&MMS, Business Office, FMS, etc.)
 Action



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 4.1.3.b    Standardize purchases across the Network where possible
 4.1.3.c    Undertake ongoing analyses of space utilization to ensure optimal use of
            existing infrastructure
Strategy    Establish supportive processes to facilitate reduction of waste
  4.1.4
 Action     Establish consolidated data management unit for the collection and analysis
 4.1.4.a    of data and reports
 Action     Develop and implement a standardized “make-buy” decision-making tool
 4.1.4.b    that includes a template and consistent criteria for evaluation. This will be
            incorporated into the EDM process to facilitate the evaluation of proposals
            by the ELB.

Metric: Cost per FAC work
Target: Below national average, adjusted for labor market

Metric: Pharmacy, laboratory and radiology cost per unique
Target: lowest 25% of VISNs

Metric: Acute care Bed Days of Care (BDOC) and fee costs for non-VA hospital care
Target: 20% reduction over 3 years




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Goal IV: Excellence in Financial Stewardship
Objective 4.2: Ensure robust revenue stream to support organizational goals
The VA New England Healthcare System will develop processes and programs to ensure
that there are robust revenue streams to support our work.

What do we want to look like in 3-5 years?
   VISN 1 will be a leader among networks in VERA and non-allocated revenue
   We will have adequate financial resources to comfortably maintain current
      activities as well as expand programs that add value to our veteran population.


Objective 4.2: Ensure robust revenue stream to support organizational goals

Strategy    Develop a budget allocation method that rewards medical centers for
  4.2.1     generating revenue
 Action     Appoint task force to review options for allocating VISN budget to medical
 4.2.1.a    centers and to design and implement an approach that incentivizes revenue
            generation.

Strategy    Implement a program to increase the number of vested basic patients
  4.2.2
 Action     Develop outreach program to increase numbers of enrolled veterans and
 4.2.2.a    users
 Action     As part of the outreach program set targets for Network and Medical Centers
 4.2.2.b    and implement monitoring program.
 Action     Develop program to ensure vesting of maximum number of basic patients
 4.2.2.c
Strategy    Implement a program to increase the number of complex patients
  4.2.3
 Action     Performance analysis of this and other Networks to determine opportunities
 4.2.3.a    for expanding programs that place patients in complex classes in a cost
            effective way. This analysis will include specific cost and revenue figures
            and recommendations
 Action     Develop and fund programs to implement recommendations from analysis
 4.2.3.b
 Action     Develop program to provide facilities with up to date monitoring of potential
 4.2.3.c    complex patients

Strategy    Implement a program to increase non-VERA Revenue
  4.2.4
 Action     Develop and implement long term plan to increase MCCF revenue
 4.2.4.a

Metric: VISN 1 portion of obligations for all networks/VISN 1 portion of Vet Pop
Target: Be in top 25% of networks




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Metric: VISN 1 market penetration for users
Target: Be in top 25% of networks

Metric: VISN 1 vested basic patients
Target: Increase by 1% per year

Metric: VISN 1 complex patients
Target: Increase by 1% over national increase or by 2% annually, whichever is higher

Metric: % of goal for MCCF collections
Target: Top 25% of networks




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Goal V: Excellence in Service to Communities
Objective 5.1: Develop research strategic plan

VISN 1 research community will work collaboratively to enhance research efforts across
the Network. Furthermore the Network will identify opportunities for enhancement of
research and support this enhancement through financial and leadership support.

What do we want to look like in 3-5 years?
   The Network will engage in an ongoing review of its research activities and
      actively seek opportunities to enhance them
   The Network will support targeted enhancements through administrative and
      financial support
   Researchers at the different VISN Medical Centers will work together to solve
      common organizational barriers to research
   Strong collaborations will exist with Academic Affiliates and other community
      partners to seek out and engage in research of benefit to veterans.

Objective 5.1: Develop research strategic plan
Strategy
           Establish a mechanism to support research development in VISN 1.
5.1.1
  Action   Develop a VISN 1 internal research funding mechanism with RFAs & peer
  5.1.1.a  review groups to support further development of research enterprise through
           targeted support. Specific areas would include:
                Support medical center efforts to establish new research programs or
                   centers
                Assist entry-level investigators in the vulnerable first 2-5 years of
                   completing their training.
                Assist mid-career investigators as they expand their existing
                   research area or develop a new research area.
Strategy     Improve Research Support Infrastructure.
   5.1.2
  Action   Establish VISN Research Subcommittee allowing a forum to collectively
  5.1.2.a  address infrastructure and support issues that hinder research enterprise in
           VISN 1. Subcommittee would address issues such as recruitment and hiring
           process (HR), contracting, IT support, IT security and space
Strategy Work with VISN 1 affiliates to identify research opportunities that do
   5.1.3   not currently exist in the VA-system, that can lead to improvements in
           veteran’s health care.
  Action   Through VISN Research Subcommittee, Quadrad leadership, Dean’s
  5.1.3.a  Committees, local research program leaders, VISN CMO office and Service
           Line leaders, seek collaborations with academic affiliates and other
           community partners to expand research into new areas of benefit to
           veterans.



METRICS:


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Metric: VERA Research Funding $ received by VISN 1
Target: Increase Research VERA Funding by 10% per year over the next 3 years

Metric: % of VERA Research Funding received by VISN 1
Target: Become leading network in VERA Research Funding




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