Timeline

• Identify Project Champion and Core Team

  The successful implementation of this service relies on the leadership of a dedicated Project Champion and the support of a fully staffed core team. It is recommended that both an Administrative Project Champion and Clinical Project Sponsor lead this work. Their goal is not only to successfully implement Close to Me, but also to resolve issues and proactively mitigate barriers arising from the adoption of a new practice. The core team plays a direct role in the day-to-day success of the service, from planning through execution, and is made up of the Implementation team and the Clinical team.
• Set Project Scope and Plan

  Once the core team is in place, it is time to set the project scope. This will inform project goals, deadlines, tasks, resources, and stakeholders needed to successfully carry out implementation.
• Secure Service Operation Approvals and Submit CRR

  Securing service and resource approvals is imperative to the success, and more importantly, the sustainment of Close to Me. The implementation team will have to submit a Clinical Restructuring Request to obtain approval from their local leadership, VISN leadership, and VACO leadership to move forward with Close to Me. This is a requirement of VHA Directive 1143. Services cannot proceed until approval has been obtained.
• Initiate Stakeholder Engagement

  Engaging with stakeholders early and often is essential to the success of the service. Set up meetings with stakeholders to introduce them to Close to Me, as well as informally socialize the concept with key players to ensure buy-in. After the service goes live, establish a regular cadence of communication with stakeholders to keep them abreast of Close to Me service operations.
• Establish Policies and Procedures

  The integrity of this service lies within the evidence-based policies and procedures to which all staff must strictly adhere. The core implementation team must review and tailor the Standard Operating Procedures (SOPs) according to the needs of the facility, while ensuring compliance with VA Directives and guidance, accrediting body standards, and applicable state and local laws. Following this process, review all edited SOPs with the local Quality, Safety, & Value (QSV) team to ensure policies adhere to VA’s Quality and Safety standards and all aforementioned requirements.
• Build Clinics, Consults, Notes, and Grids

  Engage with the local Clinical Informatics team, Clinical Application Coordinators (CACs), and Medical Support Assistants (MSAs) early on for clinic, consult, and scheduling support. Work with the implementation and clinical teams to create a proposed clinic schedule and determine the CBOC infusion clinic days. This decision should be informed by patient volumes, as well as any other facility-specific considerations.
• Recruit Patients

  The sustainment of this service is ultimately reliant upon its patients. The team should consistently recruit ideal patient candidates for participation. Engage providers, such as Oncologists and CBOC Primary Care Physicians for help with recruiting patients. Before recruiting patients, conduct the appropriate research to decide which CBOCs are most likely to attract the highest volume of eligible patients. To aid in this decision-making process, use the Close to Me Palantir Dashboard to help illustrate trends in patient location and community care usage, informing the CBOC locations for implementation and expansion.
• Establish Data Collection and Evaluation Plan

  Once services are rolled out at the CBOCs, data collection and analysis will inform program success and justify service sustainment. Data collection will also allow the team to make process improvements as necessary. All participating sites will report their data to NOP on a quarterly basis.
• Conduct Dry Run

  A few weeks out from launching, coordinate with the implementation and clinical teams, as well as stakeholders, to conduct a ‘dry run’. This includes meeting with the core team and stakeholders to conduct a ‘table read’ of the workflow, weekly plan, and operations. The review of the workflow will help to identify risks and preemptively enact mitigations. It is also recommended to demonstrate the consult submission and patient enrollment processes, review safety protocol drills, and allow time for staff questions or concerns.
• Go-Live and Establish Quality Improvement Process

  After Close to Me is operational, plan to connect and debrief with the team during the first few days or weeks to discuss what has gone well, what can be improved, and any concerns the team may have.

Departments

• Cancer care
• Hematology/Oncology
• Pharmacy
• Logistics
• Maintenance
• Administration
• Purchasing and supplies
• Risk management
• Building management
• Fleet vehicle
• Nursing services
• Quality control
• Telehealth
• Patient services
• Finance department
• Human resources
• Social services

Risks and mitigations