Using a Sustained Efficiency Model and Best Practices to Inform Evidence-Based Operational Decision Making

This commentary presents the five principles of a sustained efficiency model proven to be effective for partnering with operational and clinical partners in rigorous and rapid evaluations, utilizing a case study to demonstrate the efficacy of the model in use in a congressionally mandated Veterans Health Administration staffing evaluation initiative. The Veterans Affairs (VA) system faces increasing demands for timely, evidence-based decision making to enhance efficiency while maintaining high-quality care. To address these needs, the StrAtegic PoLicy EvIdence-Based Evaluation Center (SALIENT) developed a Sustained Efficiency Model grounded in implementation science and applied it in a congressionally mandated Specialty Care workforce evaluation. Our model integrates five interdependent principles: (1) proactive collaborative interdisciplinary partnerships that unite operational leaders, researchers, and stakeholders to enable rapid course corrections, (2) multi-level theoretical modeling that combines Lean Six Sigma, Human-Centered Design, and QUERI implementation frameworks to identify determinants of change, (3) systematic processes and strategies, as well as tailored applications and templates, (4) triangulating mixed-methods data and integrating diverse perspectives to enhance the rigor of analysis and offer real-time knowledge translation, and (5) progressive rapid iterative reporting to deliver timely findings to policy makers and congressional partners. The model's utility was demonstrated in the VA's SALIENT Staffing Project, which informed VA workforce guidelines required by the Honoring our PACT Act of 2022. Via close coordination with the Partnered Evidence-Based Policy Resource Center, the team collected and analyzed qualitative and quantitative data on an accelerated timeline, producing high-quality and relevant recommendations.