History

Overview

The VA Quality Scholars Program (VAQS) is the premier training program in quality improvement and patient safety at the United States Department for Veterans Affairs. For over 15 years, VA Quality Scholars has served as an international bellwether for training healthcare professionals in quality improvement scholarship. Alumni of the VAQS impact health care quality inside the VA and beyond including leadership positions that directly work to improve healthcare. Accomplishments of VAQS alumni include faculty positions both within and outside VA, leaders in public health organizations, deans in medical education, Quality Management Officers in VA Networks, a Chief Medical Officer and Vice President for a private hospital, a VA National leader of Medication Reconciliation, a Director of Quality Improvement for the US Army, and a White House Fellow and Leader of Senior Corps .

Founding

In the late 1990s VA leadership recognized that the VA health system possessed a confluence of organization strengths that provided an appropriate setting for a training program dedicated to the improvement of healthcare quality and value. These strengths include a national health system focused on improvement and safety, an array of academic affiliations with leading medical and nursing schools, and an administrative structure that promoted innovative training opportunities (i.e., the Advanced Fellowships Program in the VA Office of Academic Affiliations). After negotiations with colleagues at The Dartmouth Institute at Dartmouth Medical School, a plan was developed for a two-year post-residency fellowship in the improvement of health care, the VA National Quality Scholars Program.

The Program began in 1998 with a ‘hub and spokes’ model. The Dartmouth Institute served as the hub developing the program infrastructure and curriculum as well as recruitment of the first cohort of fellows. The Dartmouth Institute served as the Coordinating Center for the VA Quality Scholars curriculum over the subsequent years. Originally, the spokes of VAQS included six VA facilities (Birmingham, AL; Cleveland; Iowa City; Nashville; San Francisco; White River Junction, VT) and their medical school affiliates. Faculty leaders at each site established a clearly identifiable program that encouraged collaboration among the administrative leadership, e.g., the facility director, VA network director, the VA network quality management officer, and deans and department chairs at the affiliated medical, nursing, public health, public administration, business administration, or health administration school. In addition, they worked closely with clinical leadership, including the chief of staff, clinical service manager, and appropriate clinical service chiefs, to ensure a program that would contribute value to patient care. The VAQS Program enrolled its first physician fellows in 1999.

Interprofessional Education and Program Expansion

Given the interprofessional nature of healthcare teams and the particularly prominent role of nursing in quality improvement and patient safety, the VA Office of Academic Affiliations, encouraged the integration of nurse fellows at all VAQS program sites. In 2009, the first doctoral-prepared nurses matriculated as VAQS program fellows. With support from the Quality and Safety Education for Nursing (QSEN), nursing faculty were integrated into each of VAQS sites. All VAQS sites were henceforth co-lead by a physician and nurse senior faculty scholar. Furthermore, a competitive program expansion occurred in 2012 with two new sites, Atlanta VA and the Greater Los Angeles VA, added to the overall VAQS program. Both sites were chosen because of their strengths as leaders in interprofessional education. Today the VAQS program includes physicians and pre- and post-doctoral nurses as fellows who participate in an interprofessional fellowship curriculum. Further expansion for other health professionals is under consideration. For example, the San Francisco VA site has a clinical psychology faculty member and is recruiting postdoctoral psychologists as fellows on a trial basis.

Current Program Structure

The VAQS program now includes eight sites in different geographic locations across the United States (Atlanta, GA; Birmingham, AL; Cleveland, OH; Greater Los Angeles, CA; Iowa City IW; Nashville, TN; San Francisco, CA; and White River Junction, VT). In addition, an independently funded VAQS program in Toronto, Canada was added in 2011 and is part of the Centre for Quality Improvement and Patient Safety at the University of Toronto. 

In 2014, the Center for Training in Healthcare Quality at the Michael E DeBakey VA Medical Center in Houston, Texas was awarded the role of VAQS Coordinating Center after a competitive application process.  The Center for Training in Healthcare Quality is an established quality improvement, patient safety, and health services research education and training program within the Houston Center for Innovations in Quality, Effectiveness, and Safety (IQuESt) at the Houston VA and Baylor College of Medicine.  The Houston Coordinating Center is responsible for development and delivery of the VAQS curriculum, program evaluation, conducting the annual VAQS Summer Institute, and assisting sites with marketing and recruitment.

Each US site is located at a VA medical center and partnered with an academic medical center and university. Sites function independently. Each site is directed by two Senior Scholars, an accomplished academic physician and doctoral-prepared nurse, and one or more other faculty experienced in mentoring and research in health care quality and patient safety. Mentoring is a critical part of the program and Senior Scholars view each fellow as an individual with unique needs. Senior Scholars’ approach is designed to nurture each fellow to develop a career whether in research in quality improvement and health services or in quality improvement practice within the framework or a position in medical administration or clinical practice.