to main content Evaluation of the Veterans Heath Administration Diffusion of Excellence Program | The Joint Commission
Improvement Insights

A critical look at latest academic and publications research including The Joint Commission Journal on Quality and Patient Safety as well as Health Research Services initiatives with partner organizations.

Supporting Innovations in Health Care: Evaluation of the Veterans Heath Administration (VHA) Diffusion of Excellence Program


By George L. Jackson, PhD, MHA

The Veterans Health Administration (VHA) Diffusion of Excellence (DoE) program was started in October 2015 with the goal of identifying, replicating and spreading promising innovations across the VHA. Each day, many front-line VHA employees seek to develop and spread specific clinical and administrative innovations as a way of furthering VHA’s mission of service to our nation’s heroes.  

Innovations for veterans have ranged from:

  • using electronic health record (EHR) data to identify opportunities to reduce the number of prescriptions patients take
  • making the process of obtaining prosthetics and eyeglasses faster and easier
  • improving inpatient care though enhanced oral hygiene aimed at reducing non-ventilator-associated pneumonia
  • helping patients get out of hospital beds and walk sooner so that they maintain physical function

DoE offers a structured process to:

  1. Identify successful innovations from across the VHA through the VHA Shark Tank Competition in which VHA facility and regional directors serve as the “Sharks” and “bid” resources to support implementation of successful practices in their facilities. 
  2. . Facilitate replication of Shark Tank winning practices in new locations.
  3.  Collaborate with health system partners to spread highly impactful practices across the VHA with the support of DoE Diffusion Specialists.
  4.  Train VHA staff who develop successful innovation to widely distribute those innovations through a Diffusion Academy.
  5. Offer a web-based system for VHA staff to search for potential solutions to every day work challenges through the VHA Diffusion Marketplace.

Early in the DoE program, it was recognized as important to have an evaluation of the overall impact of DoE on supporting innovation across the organization. DoE partnered with the VHA Quality Enhancement Research Initiative (QUERI) – which supports efforts to evaluate implementation strategies aimed at moving interventions into practice via implementation science methods – to perform a comprehensive evaluation of DoE. 

Specifically, the Spreading Healthcare Access, Activities, Research and Knowledge (SHAARK) evaluation examined:

  • motivation for participating in the DoE program 
  • process facilities use to decide to adopt innovations
  • what leads to successful implementation of innovations in new locations

A summary of key findings form the evaluation was published in the April 2021 issue of The Joint Commission Journal on Quality and Patient Safety in an article titled “Merging Implementation Practice and Science to Scale Up Promising Practices: The Veterans Health Administration (VHA) Diffusion of Excellence (DoE) Program.”

Key findings included:

  • DoE has broad reach in the VHA. Today, six Shark Tanks have resulted in 2,671 applications from front-line staff, resulting in 69 Shark Tank winning practices that have received replication support.*
  • Successful practice replication is more likely when there is a linkage between the “big picture” considerations of senior executives and the “on-the-ground” perspectives of staff, including through the early involvement of front-line staff.
  •  People who develop new innovations are often reacting to on-the-job observations that lead to the development of ways to make things better. A challenge when spreading the innovation is to translate this passion to new locations and people.
  • It is important to have a clear understanding of what is needed for successful implementation in new locations, commitment of needed resources and a clear understanding by senior leadership of the people responsible for making implementation successful.
  • Facilities often work through challenges to make implementation of innovations a reality even if it takes longer than originally expected.
  • The facilities that developed and initially replicated practices through DoE are frequently able to sustain those practices (approximately three-quarters of reporting facilities) and there have been hundreds of additional efforts to implement DoE practices broadly across the VHA.
  • Identifying, replicating and spreading innovations in a large organization is hard work and can be enhanced through clearly delineated roles, responsibilities and specific tools to support the process.

For more information on DoE and its sister programs in the VHA Innovation Ecosystem, please visit 

*Data updated from April 2021
JQPS article.

George L. Jackson, PhD, MHA, is a Research Health Scientist and Implementation and Improvement Science Lab/Core Director in the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAP) at the Durham Veteran Affairs Health Care System and Professor in the Departments of Population Health Sciences, Medicine (Division of General Internal Medicine), and Family Medicine and Community Health at Duke University, Durham, North Carolina. The views expressed in this blog are those of the author and do not reflect the position or policy of the U.S. Department of Veterans Affairs, the U.S. government or Duke University.