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VA research in action

Improving care for Veterans in VA community living centers

August 1, 2018


Photo by Jeff Bowen

The Bright Spots Program has improved care of Veterans in VA's community living centers. A pilot project by researchers as the Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Massachusetts, has impacted care for around 40,000 Veterans residing in 135 CLCs across the country.

Their intervention is called LOCK, which stands for 1) Look for the bright spots, 2) Observations by everyone, 3) Collaborate in huddles, and 4) Keep it bite-sized. LOCK was rolled out nationally in 2017. It trains staff to huddle at the frontline about quality-of-care issues. For example, in a 5- to 15-minute meeting, CLC staff might review risk factors for pressure ulcers, talk about residents who are at risk but do not have pressure ulcers to learn from these "bright spots," and brainstorm about potential pressure ulcer causes and small changes the group will try. These rapid quality-improvement steps are made "bite-size" and, thus, sustainable for busy frontline staff.

Project title: Developing and implementing a toolkit for measuring CLC cultural transformation

Principal investigators: Christine W. Hartmann, PhD, A. Lynn Snow, PhD; Edith Nourse Rogers Memorial Veterans Hospital

Selected publications:

Hartmann C, Palmer J, Mills W, Snow AL, Pimentel CB, Allen RS, Wewiorski NJ, Dillon KR. Adaptation of a nursing home culture change research instrument for frontline staff quality improvement use. Psychol Serv. 2017 Aug; 14(3):337-346.

Mills WL, Pimentel CB, Palmer JA, Snow AL, Wewiorski NJ, Allen RS, Hartmann CW. Applying a theory-driven framework to guide quality improvement efforts in nursing homes: the LOCK model. Gerontologist. 2018 May 8;58(3):598-605


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