36C10X18Q0171-0001001.docx

36C10X18Q0171

PAGE 1 OF

1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

DUNS:

DUNS+4:

PHONE:

FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. 2/2012)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

101-18-2-6377-0006

06-01-2018 David Rupert 240-215-1763 07-02-2018

2PM ET

Strategic Acquisition Center - Frederick Department of Veterans Affairs 321 Ballenger Center Drive, Suite 125

Frederick MD 21703

X

541611 $15 Million

X

N/A

See Section B.4 PWS

Strategic Acquisition Center - Frederick Department of Veterans Affairs 321 Ballenger Center Drive, Suite 125

Frederick MD 21703

See Section B.1 Contract Administration

See CONTINUATION Page VHA Quality Governance This is a tiered evaluation. An offer must indicate which tier they are responding to. This solicitation is being issued as a tiered evaluation for SDVOSB concerns, or in the alternative, a tiered evaluation for VOSB concerns, or in the alternative, a set-aside for other small business concerns with HUBZone small business concerns and 8(a) participants having priority. If award cannot be made, the solicitation will be cancelled and the requirement resolicited.

Please see Section E.1 for more information.

See Section B.3 for PWS.

Questions due on 6/11/2018 by 12pm ET Bid intentions are due on 6/20/2018 by 12 noon

See CONTINUATION Page

Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

1. Contract Administration: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR: TBD

b. GOVERNMENT: Contracting Officer 36C10X Melissa Maloy Strategic Acquisition Center - Frederick Department of Veterans Affairs 321 Ballenger Center Drive, Suite 125 Frederick MD 21703

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:

3. INVOICES: Invoices shall be submitted in arrears:

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests.

TUNGSTEN (fka OB10) ELECTRONIC INVOICE SUBMISSION FSC e-INVOICE PROGRAM THRU AUSTIN PORTAL

FSC MANDATORY ELECTRONIC INVOICE SUBMISSION FOR AUSTIN PAYMENTS

Contractor POC: TBD Contracting POC: David Rupert – David.Rupert@va.gov COR (Contracting Officers Representative): TBD Contract/Task Order Number: TBD Purchase Order Number: TBD

Vendor Electronic Invoice Submission Methods:

Fax, email and scanned documents are not acceptable forms of submission for payment requests. Electronic form means an automated system transmitting information electronically according to the accepted data transmissions below.

• VA’s Electronic Invoice Presentment and Payment System – The Financial Services Center (FSC) in Austin, TX uses a third-party contractor, Tungsten, to transition vendors from paper to electronic invoice submission. Please go to this website: http://www.tungsten-network.com/US/en/veterans-affairs/ to begin submitting electronic invoices, free of charge.

• A system that conforms to the X12 electronic data interchange (EDI) formats established by the Accredited Standards Center (ASC) chartered by the American National Standards Institute (ANSI). The X12 EDI Web site is http://www.x12.org.

Vendor e-invoice Set-up information:

Please contact Tungsten at the phone number or email address listed below to begin submitting your electronic invoices to the VA Financial Services Center in Austin, TX for payment processing. If you have questions about the payment status of a properly submitted invoice, the e-invoicing program, or Tungsten, please contact the FSC at the phone number or email address listed below.

• Tungsten e-Invoice setup information: 1-877-489-6135

• Tungsten e-Invoice email: VA.Registration@tungsten-network.com

• VA TUNGSTEN Number: AAA544240062

• FSC e-Invoice contact information: 1-877-353-9791

• FSC e-Invoice email: vafsccshd@va.gov

• http://www.fsc.va.gov/einvoice.asp

COMMUNICATIONS:

• https://www.federalregister.gov/articles/2012/11/27/2012-28612/va-acquisition-regulation-electronic-submission-of-payment-requests

• http://fcw.com/articles/2012/11/27/va-epayments.aspx?s=fcwdaily

5. ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

B.2 LIMITATIONS ON SUBCONTRACTING-- MONITORING AND COMPLIANCE (JUN 2011)

This solicitation includes VAAR 852.219-10 VA Notice of Total Service-Disabled Veteran-Owned Small Business Set- Aside; VAAR 852.219-11, VA Notice of Total Veteran-Owned Small Business Set-Aside; and FAR 52.219-14, Limitations on Subcontracting. Accordingly, any contract resulting from this solicitation will include this clause. The contractor is advised in performing contract administration functions, the CO may use the services of a support contractor(s) retained by VA to assist in assessing the contractor's compliance with the limitations on subcontracting or percentage of work performance requirements specified in the clause. To that end, the support contractor(s) may require access to contractor's offices where the contractor's business records or other proprietary data are retained and to review such business records regarding the contractor's compliance with this requirement. All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and Non-Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the contractor's business records or other proprietary data reviewed or obtained in the course of assisting the CO in assessing the contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs. Furthermore, if VA determines any services the support contractor(s) will perform in assessing compliance are advisory and assistance services as defined in FAR 2.101, Definitions, the support contractor(s) must also enter into an agreement with the contractor to protect proprietary information as required by FAR 9.505-4, obtaining access to proprietary information, paragraph (b). The contractor is required to cooperate fully and make available any records as may be required to enable the CO to assess the contractor's compliance with the limitations on subcontracting or percentage of work performance requirement.

B.3 PERFORMANCE WORK STATEMENT (PWS)

1.0 BACKGROUND

The Veterans Health Administration (VHA) is committed to providing Veterans with timely, accessible, and high-quality care. The Department of Veterans Affairs (VA) intends to honor this commitment by improving performance, promoting a positive culture of service, increasing operational effectiveness and accountability, advancing healthcare innovation through research, and training future VA clinicians. VA recognizes that while the healthcare landscape is constantly changing, VA’s unique population and broad geographic demands will continue to require community-based care for Veterans. A Veteran enrolled in the patient enrollment system of VA, established and operated under 38 U.S.C. § 1705, may receive services under these VA Choice contracts. Healthcare services will be provided in each state as defined in 38 U.S.C. § 101(20). As part of this obligation to provide care in the community, VA intends to award a Community Care Network contract to qualified managed care support suppliers. This network will need to seamlessly integrate with the VHA’s enterprise care delivery assets and must include the ability for Veterans to choose where they receive care. To better inform Veterans’ choice, VHA will provide Veterans and stakeholders outcome data from both private sector care and VHA facilities for the given types of care. In addition, VA has been cited for inconsistent quality oversight and follow-through with improvement activities, necessitating a modern system with a more standardized, comprehensive framework around quality governance.

The VHA Office of Quality Safety and Value (QSV) vision is to be the world’s best integrated health care system through continuous improvement, measurement, and transparency. The VHA is committed to providing Veterans with timely, accessible, and high-quality care. To achieve this vision, VHA is spearheading transformative efforts to operate as a High Reliability Organization (HRO), which involves creating a healthcare environment that focuses on continuous quality improvement where every patient experiences safe, high-quality, efficient and timely care.

QSV requires support in creating a quality governance structure backed by an effective quality operational model for ongoing improvements, accountability at all levels (in quality, safety, satisfaction and financial areas) and integrated performance reporting.

QSV’s vision of a shared governance is a system that is patient‐centered; leveraging a framework that provides horizontal links for peer learning and vertical links for oversight and accountability. It breaks-up traditional research and clinical silos and combines basic and applied research with health-system operations. The result of which, creates a system that aligns the goals and strengths of a wide and diverse set of stakeholders to include clinicians, patients, researchers, and administrators towards common outcomes.

In preparation for this transition, VA is embarking on a major transformation to operate as a High Reliability Organization (HRO) – creating a healthcare environment that focuses on continuous quality improvement where every patient experiences safe, high-quality, efficient and timely care. This journey will promote a culture that anticipates and recovers from risks, rewards respectful interactions based on trust and values, promotes speaking up, and is committed to a unified purpose of preventing harm and eliminating waste while continuously improving quality and the Veteran experience. To achieve this vision, the VHA must focus on:

· Improving governance, accountability and integrated performance reporting

· Understanding clinical risk at the provider, unit and system level

· Enabling an operating model that supports continuous, enterprise-wide learning and improvement

· Ensuring the Veteran and family are at the center of all care experiences To begin the HRO journey, the VHA implemented a proof of concept, new clinical quality, safety and value oriented governance structure leveraging high reliability principles and cascading accountability structures to support and enable care teams at every level of the organization. Research, academic and healthcare contract support were utilized to co-design a governance structure based on previous published fractal models. As part of ongoing model adjustment, the VHA will refine clinical business processes, organizational and decision structures, performance and accountability measures, training requirements, reporting and incentives, and adaptive behavioral norms regarding transparency, communications, trust, respect and teamwork. The objective of this new operating model will be to begin the HRO journey by organizing, training, incentivizing and enabling VA staff to continue to provide high quality, empathetic, safe care supported by a just workplace culture. The resulting transformation will yield improvements in quality, safety, employee and patient satisfaction as well as operating effectiveness (throughput and cost).

2.0 APPLICABLE DOCUMENTS

See Attachment A: IT CONTRACT SECURITY.

3.0 SCOPE OF WORK

The contractor shall provide professional and technical services, subject matter expertise in applying business compliance techniques to clinical quality and safety oversight, and strategic advice to VA as it refines and diffuses the governance model initiated in the proof of concept project. Utilizing strong project management skills, the contractor shall perform work in the following areas:

a. Refine the proof of concept strategy around a governance structure and functional model, based on HRO principles

b. Develop an implementation plan to spread an HRO governance model across the Enterprise

c. Support a cascading implementation throughout the enterprise, to include simultaneous implementation across large numbers of hospitals at the same time.

The contractor’s approach for the HRO operating model design and implementation shall engage and enable key stakeholders (VA, VHA, Veterans Integrated Service Network (VISN), VA Medical Center (VAMC), department, and unit leaders) to plan, operationalize, and manage HRO transformation efforts across VA to achieve the Secretary’s goal of enabling Veterans a true choice regarding their healthcare services.

To execute the work, the contractor shall leverage its experience and capability to ensure that the organization’s most senior leaders and front line clinical teams are aligned and committed to the new paradigm for service delivery. The contractor shall deliver its expertise and capability to VHA to execute the following objectives:

· Leading, facilitating and creating HRO cultural transformations through engaged leaders, particularly using the fractal model or comparable for quality governance, a well-published and effective model for quality management.

· Designing and implementation planning for HRO transformation services – with demonstrable business improvements clearly aligned to VA’s vision, mission, goals, and objectives across the 4 pillars of excellence: quality, safety, access and experience.

· An operational approach that leads to buy-in, commitment up and down the management chain, and effective accountability to service Veterans.

· An operational approach that incorporates 3-lines of defense risk management foundational principles.

· Knowledge transfer to existing leaders, which enables them to cascade a commitment to a common vision and mission and which can be demonstrated through personal and organizational performance measures.

· Systematically integrate talent development and succession planning with a well-developed performance management process.

4.0 PERFORMANCE DETAILS

4.1 PERFORMANCE PERIOD

The period of performance for this Task Order (TO) is 16 months from award with a 4 month base period and 3, three month option periods.

4.2 PLACE OF PERFORMANCE

The contractor shall perform efforts under the PWS primarily at contractor facilities and at Government site(s) as directed by the Government. The primary places of performance for the base period will be in VISN 10, mid-west area. Optional periods will involve scale and spread for Enterprise-wide implementation.

Any work at a Government site shall not take place on Federal holidays or weekends unless directed by the Contracting Officer (CO) or the Contracting Officer’s Representative (COR). Section 4.0 of the ID/IQ PWS defines Federal holidays.

4.3 TRAVEL

4.3 TRAVEL

The Government anticipates travel under this effort to perform the tasks associated with the effort, as well as well as to attend program-related meetings or conferences throughout the Period of Performance (POP). The Government encourages the contractor to maximize its use of teleconferencing and videoconferencing for meetings. Travel and per diem, if required, shall be reimbursed in accordance with FAR 31.205-46, Travel costs. Each contractor invoice must include copies of all receipts that support the travel costs claimed in the invoice. Travel must be pre-approved by the COR. Local travel within a 50-mile radius from the contractor’s facility is considered the cost of doing business and will not be reimbursed. This includes travel, subsistence, and associated labor charges for travel time. Travel performed for personal convenience and daily travel to and from work at the contractor’s facility will not be reimbursed. Travel, subsistence, and associated labor charges for travel time for travel beyond a 50-mile radius of the contractor’s facility are authorized on a case-by-case basis and must be pre-approved by the COR. General and Administration expenses will not be reimbursed.

The responsible VHA Program Office is in Washington, DC. For purposes of model refinement, the work will be primarily in Ann Arbor and Saginaw, Michigan. For purposes of spread, two additional sites in the Midwest will be identified. Locations for the spread to other VISNs in option period have not yet been determined. For purposes of estimation, the Government used Washington DC, and Ann Arbor, MI as travel destinations

Base Travel Estimate:

Optional Effort(s) Travel Estimate:

4.4 CONTRACT MANAGEMENT

The Contracting Officer is responsible for providing overall oversight, maintaining communication between the Contractor and VA, ensuring contract compliance, administering the contract (including overseeing payment or rejection of invoices), issuing modifications, and ensuring that annual performance evaluations are completed.

In support of the responsibilities above, the CO will designate a Contracting Officer’s Representative (COR) from the program with limited authority. Additional program stakeholders (program manager, etc.) responsible for the effort’s outcomes may also interact with contractor personnel, with the COR being the contractor’s primary interface to the Government.

See B.1 Contract Administration Data for personnel responsible for contract administration.

4.5 GOVERNMENT FURNISHED PROPERTY (GFP)

The Government will furnish property to the contractor for use in the performance of this contract/task order. GFP (materials, equipment, and/or information) will be provided in conjunction with required performance, as determined by agreement between the Government and the contractor. The contractor purchase of hardware or software tools, unless approved for this PWS, must be pre-approved by the COR.

VA will provide the contractor with access to manuals, routine reports, and related materials necessary to perform. VA will provide the contractor with access to VA systems or environments required to accomplish work within the scope of this PWS, subject to VA security requirements.

The contractor shall have, at the Government’s discretion, access to internal program documentation as well as program-related meetings hosted by either the Government or support contractors. The contractor’s access to documentation and meetings shall be to collect information for analysis or providing advice in accordance with the objectives of this PWS.

All GFP shall be reported at the contract level, within the contractor staffing roster. At the written request of the Government, the contractor shall immediately return any property provided by the Government for the contractor’s use to complete the assigned subtasks under this PWS. If not requested, the contractor shall continue to abide by Federal Acquisition Regulation Part 45 until completion of the contract.

4.6 SECURITY

When performing observations, the contractor will be exposed to privileged information under 38 U.S.C. 5705. The contractor may view copies of reports, minutes, and hear discussions about this privileged information, but will not have their own copy to keep or store. These reports and minutes may be viewed by the contractor during virtual or on-site meetings but will not be available to them electronically. Access to a SharePoint will be used for non-protected data, such as policies, templates and other materials necessary for the contractor to complete associated tasks. The C&A requirements do not apply, and a Security Accreditation Package is not required

The contractor shall use its own computers and servers to develop tools and develop work products for VHA. The contractor will not have access to internal VA IT systems. Additionally, the contractor’s computers may be used for communication and platforms for training. At no time, will the contractor have access to store any confidential or privileged VA information on contractor IT systems. See ATTACHMENT A: IT CONTRACT SECURITY.

4.6.1 POSITION/TASK RISK DESIGNATION LEVEL(S) AND CONTRACTOR PERSONNEL SECURITY REQUIREMENTS

The position sensitivity and the level of Background Investigation (BI) commensurate with the required level of access for the following tasks within the PWS are:

Position Sensitivity and BI Requirements

The Tasks identified and the resulting Position Sensitivity and BI requirements identify the BI requirements for contractor individuals, based upon the tasks the contractor individual will be working. The submitted contractor Staffing Roster shall indicate the required BI level for each contractor individual, based upon the task(s) the individual will be working.

5 SPECIFIC TASKS AND DELIVERABLES

5.1 PROJECT MANAGEMENT AND REPORTING

The contractor shall manage the work program and provide the Government necessary feedback regarding progress. The contractor shall provide a Contractor work plan with timeline and milestones, and monthly progress reports. The format of deliverables will be at the discretion of the VA (i.e. Microsoft project, etc.).

The contractor shall provide a baseline, interim, and post-performance analysis report that addresses methods for assessment, intervention, and evaluation of VA’s Quality Council at each VISN and VAMC level for effectiveness in making improvements in clinical quality, safety, access, efficiency, and patient satisfaction.

5.1 Deliverables:

A. Contractor work plans B. Monthly progress reports C. Project management tool/plan reflecting project status D. Baseline/Interim/Post-Performance Analysis Report. (Due 30, 75 and 120 days after award, respectively).

5.2 GOVERNANCE ASSESSMENT

The contractor shall conduct a baseline assessment, at a minimum of two new implementation sites, of current governance structures and processes for the identification and escalation of risks vertically throughout the organization and sharing lessons horizontally. This assessment shall include an evaluation of an infrastructure that supports unit based awareness of the 4 pillars of excellence: quality, safety, access and experience outcomes. Additionally, this assessment shall include an evaluation of the internal processes that exist to identify emerging risks, quality concerns or other issues where attention and improvement activities should focus. The process for the gap assessment will be converted into a self-assessment tool that the Government can use to start evaluating new sites in anticipation of escalation of spread during the option period.

The assessment at the two flagship sites will look at recent efforts to continue the implementation and barriers within organizational structure to identify duplication of efforts and opportunities to ensure that clinician work is targeted towards the pillars of excellence. A report that identifies redundancies and helps to prioritize roles and responsibilities of clinicians and administrators will be used to support Task 5.3 execution with the intention of removing responsibilities as new ones are added.

5.2 Deliverables:

A. Gap Assessment Tool (Due 60 days post award date) B. Change Management Plan (Due 60 days post award date) C. Report on clinician time utilization (Due 90 days post award)

5.3 EXECUTION/IMPLEMENTATION/REFINMENT

The fractal governance model or comparable will be implemented at a minimum of two additional facilities in VISN 10, while supporting the continued implementation and refinement at the 2 flagship sites in VISN 10.

The implementation shall include training and coaching of front line staff for the identification of opportunities across the pillars of excellence. It is expected that staff will learn how their work contributes to outcome measures across the pillars of excellence. It is expected that clinical leaders will learn to identify and utilize resources and subject matter experts to help develop a deeper and more comprehensive understanding of the metrics across the 4 pillars of excellence that apply to their services and units. Deep dives and other performance improvement processes will be used for data validation when performance does not meet expectations or to assess risks and concerns identified by team members. This front-line infrastructure should allow for development of improvement initiatives from those closest to the Veteran. The method of implementation should be formatted for a virtual approach to support faster spread and inclusion of stakeholders from multiple locations. The implementation shall identify first line of defense activity, for daily monitoring of risks across the pillars of excellence.

The implementation will support accountability at the Service Chief level for supporting and resourcing improvement efforts across the 4 pillars of excellence. Resourcing improvements, include horizontal collaboration with other services within the organization and across the enterprise, addressing similar risks and opportunities. The Service Chief is responsible for the consolidated report utilizing a structured communication process to the Healthcare System governing body that has oversight of the 4 pillars of excellence. This structured communicating process will utilize plain-language conversion of clinical topics to promote understanding by business, administrative and other non-SME stakeholders. The method of implementation should be formatted for a virtual approach to support faster spread and inclusion of stakeholders from multiple locations. The implementation shall identify first line and second line of defense activities to validate process in place by front line staff.

The implementation will support accountability at the Healthcare System level for providing resources to assist in complex analysis (i.e. internal quality, safety and improvement staff or external data experts) The Healthcare System leader is ultimately responsible for the consolidated report utilizing a structured communication process to the VISN governing body that has oversight of the 4 pillars of excellence. The structured communication process will utilize plain language conversion of clinical topics to promote understanding by business, administrative and other non-SME stakeholders. The implementation shall identify second line of defense activities to validate processes in place by services.

The implementation will support accountability at the VISN level for providing resources to assist in complex analysis (i.e. external quality, safety and improvement consultants or external data experts) The VISN leader is ultimately responsible for the consolidated report utilizing a structured communication process to the National governing body that has oversight of the 4 pillars of excellence. The structured communication plain-language conversion of clinical topics to promote understanding by business, administrative and other non-SME stakeholders. The implementation shall identify second line of defense strategies to validate process in place by Healthcare Systems.

The implementation will support accountability at the National level for providing resources to assist in complex analysis (i.e. external consultants, research funding, policy initiatives) The National level committee works within the VHA governance structure to support risk mitigation efforts. The implementation shall identify second and third line of defense strategies to validate processes and outcomes throughout the enterprise.

Face to face engagements will be limited, but may be used, as necessary, to provide practice, coaching and feedback. On-site support for the presentation of the consolidated reports may be one example. This allows for feedback on the development process, answering questions and addressing challenges from that process, coaching on the presentation, and working with the facility on how disparate reports might come together for an organizational report for the next level.

5.3 Deliverables:

A. Virtual training for unit based teams (45 days post award) B. Virtual support/office hours for action plan development (60 days post award) C. Virtual support for the development of the plain language summary report for communication of accomplishments and challenges across the 4 pillars of excellence (90 days post award) D. Practice and feedback on the presentation of consolidated reports at the healthcare system, VISN and national groups with oversight for the 4 pillars of excellence (105 days post award)

5.4 INTEGRATION/ SUSTAINMENT PLAN

During the virtual office hours and action plan developments, trends in the identification of metrics that better reflect the results of individual units will be identified. For example, some metrics may be comprised of multiple sub-metrics. As teams are drilling down and understanding the metrics, recommendations for building dashboards will be developed. This includes the inclusion of comparative metrics from non-VA healthcare facilities.

Additionally, during the implementation phase, feedback from the units regarding the monitoring of performance on the pillars of excellence will be collected and evaluated to use in the development of dashboards that may be used or adapted at the service level for improved alignment of daily work with organizational outcomes. Building in a first-line of defense for the service level is the goal of the dashboard and daily work.

5.4 Deliverables:

A. Dashboard recommendations for unit level monitoring of pillars of excellence (120 days post award) B. Recommendations for unit QA activities to inform action and identification of risks (120 days post award) C. Recommendations for consolidated reporting template for communication (120 days post award) D. Recommendations for tracking items at each level of governing body (120 days post award)

5.5 REPLICATION UP TO SIX VISNs (OPTIONAL 4 MONTH TASK)

Taking the lessons learned and tools identified for sustainment in the base period, the contractor shall implement the fractal model or comparable in up to 6 more VISNs and their associated healthcare systems.

The Government will utilize the gap assessment tool from the base period to conduct a self-assessment. The contractor, shall perform a sample of assessment to validate the accuracy of use by the Government. The results of both the Government and contractor assessment shall be used to develop the change management plan.

The implementation plan will continue to utilize a predominantly virtual approach to work through the infrastructure developed in the base period. Travel to a centralized location in a network will be utilized instead of travel to each individual healthcare system for support of the implementation, as needed. Prior to implementation, the Government will have provided just culture training to facility leadership at all locations in advance of replication. Additionally, the Government will have shared and socialized dashboards around pillars of excellence that align with unit level monitoring opportunities.

5.5 Deliverables:

A. Report on gap assessment B. Change Management Plan foundational plan tailored to each VISN C. Virtual training for unit based teams D. Virtual support/office hours for action plan development E. Virtual support for the development of the plain language summary report for communication of accomplishments and challenges across the 4 pillars of excellence F. Practice and feedback on the presentation of consolidated reports at the healthcare system, VISN and national groups with oversight for the 4 pillars of excellence

5.6 SUPPORTED REPLICATION UP TO SIX VISNs (OPTIONAL 4 MONTH TASK)

Taking the lessons learned and tools identified for sustainment in the base period and first option, the contractor shall support implementation the fractal model or comparable in up to 6 more VISNs and their associated healthcare systems. VHA staff from the initial implementation sites and VACO program offices, will be utilized to support implementation in anticipation of Government’s responsibility for continuance and sustainment.

Assessments in this option period should be conducted by the participating sites, utilizing governance assessment tools. The implementation plan will continue to utilize a predominantly virtual approach to work through the infrastructure developed in the base period. Travel to a centralized location in a network will be utilized instead of travel to each individual healthcare system for support of the implementation, as needed. Prior to implementation, the Government will have provided just culture training to facility leadership at all locations in advance of replication. Additionally, the Government will have shared and socialized dashboards around pillars of excellence that align with unit level monitoring opportunities.

5.6 Deliverables:

A. Change Management Plan B. Virtual training for unit based teams C. Virtual support/office hours for action plan development D. Virtual support for the development of the plain language summary report for communication of accomplishments and challenges across the 4 pillars of excellence E. Practice and feedback on the presentation of consolidated reports at the healthcare system, VISN and national groups with oversight for the 4 pillars of excellence

5.7 REPLICATION AND FOCUSED ASSESSMENT (OPTIONAL 4 MONTH TASKS)

Taking the lessons learned and tools identified for sustainment in the base and initial option periods, the contractor shall oversee and support VHA implement of the fractal model or comparable in all remaining VISNs. Assessments and training will be conducted by VHA staff, with support of the contractor in clarifying issues, coaching and providing feedback to trainers.

The implementation plan will continue to utilize a predominantly virtual approach. Travel to a centralized location in a network will be utilized instead of travel to each individual healthcare system for support of the implementation, as needed. Prior to implementation, the Government will have provided just culture training to facility leadership at all locations in advance of replication. Additionally, the Government will have shared and socialized dashboards around pillars of excellence that align with unit level monitoring opportunities.

While the replication continues at the remaining sites, the contractor will conduct at least 10 and not more than 20 deep dives on implementation at different sites identified by the Government. The deep dive is expected to identify examples where the governance infrastructure and processes are supporting early identification and mitigation of risks. Additionally, the deep dive will inform the Government of ongoing gaps, inconsistencies and other variations that continue to expose the Government to the risk that processes are not supporting early identification and mitigation of risks.

5.7 Deliverables:

A. Feedback sessions for VHA trainers B. Virtual support/office hours for action plan development C. Virtual support for the development of the plain language summary report for communication of accomplishments and challenges across the 4 pillars of excellence D. Practice and feedback on the presentation of consolidated reports at the healthcare system, VISN and national groups with oversight for the 4 pillars of excellence E. Summary report of impact and vulnerabilities with governance infrastructure and processes.

F. Summary article to be published in a peer reviewed academic and/or medical journal

6.0 DELIVERY SCHEDULE

All Contractor-provided work products are to be furnished within the specified delivery dates (see below). Any changes to delivery dates must be discussed with the COR and requested in writing to the Contracting Officer (CO).

Schedule of Deliverables (DOA = Date of Award), Days are calendar days

BASE PERIOD – 4 months

OPTIONAL TASKS (to be exercised within 4, four month option periods)

If for any reason any deliverable cannot be met within the scheduled time frame, the Contractor shall explain the reason for delay in writing to the COR and to the CO. As part of this notice, the Contractor shall make a firm commitment of when the work shall be completed. This notice to the COR shall include, but not be limited to the following:

· Reasons for the delay;

· Modified delivery date;

· Impact on the overall project; and

· A revised project plan with all adjusted dates.

The COR will then review the information and submit a recommendation to the CO. The CO shall review the information and issue a response in accordance with applicable regulations.

The Contractor shall provide to the Government in draft form two hard copies and one soft copy using the Microsoft Office Suite format via electronic mail and web based online format of each written deliverable to the Government not later than 12:00 noon on the due date. The Government will have ten working days to review the draft deliverable and provide comments back to the Contractor. The final deliverable shall be provided by the Contractor within five working days after the comments are received from the Government.

7.0 PERFORMANCE METRICS

Successful Performance and Remedies: Successful performance will result in favorable Past Performance Ratings and may make the Contractor eligible for award of logical follow-on opportunities, if applicable. Successful performance will be met if the performance standards are exceeded over a period of one year as determined by the CO using input received from the COR. Remedies for non or poor performance of work include poor past performance ratings to be used as part of the evaluation for all future task competitions, not awarding logical follow-on opportunities, notification to Contractor’s corporate headquarters of poor performance (if applicable), and non-payment either for services not performed satisfactorily or unacceptable deliverables.

The Contractor shall monitor performance against the established schedule, milestones, risks, and resource support outlined in the approved PMP. The Contractor shall report any deviations to the COR.

As a minimum, the following metrics shall be included:

The table below defines the Performance Standards and Acceptable Performance Levels for Objectives associated with this effort.

Format/medium to be determined by the Government.

95% of reports are on time. 95% of reports are comprehensive. 95% of timelines are met (*unless the Government action results in delay)

Perform clinician time assessment at initial proof of concept sites

Gap assessment identifies uniqueness of each organization to incorporate into change management plan

Clinician time assessment report will identify workload reduction opportunities to incorporate into change management plan

For validation/verification of implementation actions, see evaluation, below.

Meeting milestones identified 95% of the time