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While the Government Accountability Office (GAO) has reported policy, process and training concerns for the operations of the national VA Healthcare system, the leadership team of the John D. Dingell VA Medical Center in Detroit has been proactive in building a culture of continuous improvement. The Detroit VA leadership team embarked on a journey of instituting comprehensive lean practices and standardized work processes across the organization to improve operations and quality of care. In conjunction with fostering a strong quality culture within the organization, the team also expanded their horizons to seek specialized professional expertise to help deliver on the organization’s mission:

To provide timely, compassionate and high-quality care to those we serve by encouraging teamwork, education, research, innovation, and continuous improvement.

Furthering the mission led the Detroit VA leadership to the TWI Institute for consulting, training and coaching programs (Contract #36C25019C0225) in the following areas: sentinel events and quality of outcomes; streamlining, stability, consistency and improvement of processes; upgraded job instruction materials; communications across departments; enhanced intrapersonal relationships and better documentation.

The TWI Institute conducted a comprehensive assessment of processes and procedures across 14 separate service areas with the Institute subsequently recommending the implementation of TWI Job Instructions (JI) program at the facilities. JI programs develop work standards and best practices, bring stability and care for the people doing the work by instruction on preparing the worker, presenting the process or job correctly and comprehensively to the worker, rehearsing the performance of the process and making certain the worker understands completely, and following-up with the worker to observe, coach and re-assure.

While early work shows great promise, the work continues for the TWI Institute and Detroit VA teams to successfully execute this transformational job instruction improvement program and has expanded recently to address additional assignments associated with the hospital’s response to the COVID-19 pandemic. But it is clear that both teams share a vision that may prove to be a model for other VA facilities across country.

Contact the TWI Institute team to learn how you can apply TWI to create effective policies, processes and training programs within your VA Health organization.

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