Diffusion of Excellence: Accelerating the Spread of Clinical Innovation and Best Practices across the Nation's Largest Health System

UMMS Affiliation

Department of Population and Quantitative Health Sciences

Publication Date


Document Type



Health Services Administration | Health Services Research | Military and Veterans Studies


The time it takes for clinical innovation and evidence-based practices to reach patients remains a major challenge for the health care sector. In 2015, the Veterans Health Administration (VHA) launched the Diffusion of Excellence Initiative aimed at aligning organizational resources with early-stage to midstage promising practices and innovations to replicate, scale, and eventually spread those with greatest potential for impact and positive outcomes. Using a 5-step systematic approach refined over time, frontline VHA staff have submitted more than 1676 practices since the initiative's inception, 47 of which have been selected as high-impact, Gold Status practices. These Gold Status practices have been replicated more than 412 times in Veterans Affairs hospitals across the country, improving care for more than 100,000 veterans and approximately $22.6 million in cost avoidance for the VHA. More importantly, practices such as Project HAPPEN (Hospital-Acquired Pneumonia Prevention by Engaging Nurses to complete oral care) and rapid availability of intranasal naloxone have saved veterans' lives. Several practices are now being implemented across the country, and the Diffusion of Excellence Initiative is playing a pivotal role as the VHA works to modernize its health care system. This initiative serves as a promising model for other health care systems seeking to accelerate the spread and adoption of clinical innovation and evidence-based practices.


best practices, evidence-based practices, innovation health coaching, integrative, multimodal, psychiatry, wellness coaching

DOI of Published Version



Perm J. 2019;23:10.7812/TPP/18.309. doi: 10.7812/TPP/18.309. Epub 2019 Sep 19. Link to article on publisher's site

Journal/Book/Conference Title

The Permanente journal

PubMed ID


Related Resources

Link to Article in PubMed