Literature Collection

The persistent challenge of implementing meaningful and sustainable change in healthcare is well-documented. Barriers include resource limitations, technical insufficiencies, and resistance from entrenched processes and systems within hospitals, clinics, and health systems. Traditional quality improvement (QI) frameworks, while valuable, often fall short in addressing the variability and unpredictability of human behavior and decision-making that reflects the uniqueness of individual experiences and backgrounds working together in a complex organization. In response, Hackensack Meridian Health (HMH), a large integrated health system, established the Agile Institute to promote and diffuse methodologies from Agile Science (sprints, feedback loops, techniques from behavioral psychology to encourage certain behaviors, etc.) as a means to accelerate and sustain quality improvement efforts in care and patient outcomes. This narrative case study describes the conception, structure, and impact of the Agile Institute at HMH. The Institute was designed around three core pillars: training and education, consultation, and organizational identity development. Bootcamps and certification programs equipped staff across the health system with the knowledge and mindset needed to apply Agile. Consultative groups facilitated co-design sessions and iterative sprints, fostering collaboration and interdisciplinary development and implementation of innovative solutions. Intentional brand development helped to build engagement and credibility in both internal and external audiences. Over its first year, the Agile Institute achieved significant milestones: training over 130 staff, launching collaborative physician networks, and supporting system-wide initiatives that improved standardization and patient outcomes. The Institute's approach-grounded in psychological safety, stakeholder co-design, and iterative feedback-demonstrated the value of embedding Agile principles not only in QI projects but also in organizational culture. Lessons learned highlight the importance of a minimally viable, adaptable structure and the necessity of aligning Agile strategies with both system and individual priorities. The HMH Agile Institute offers a replicable model for other healthcare organizations seeking to drive sustainable, system-wide transformation through Agile.

BACKGROUND: Veterans Health Administration (VHA) has been at the forefront of offering integrated and patient-centered care to address the complex needs of more than 30,000 Veterans with HIV in the United States of America. These Veterans present with diverse cultural identities, personal values, and goals pertinent to their care, and they are often managing multiple comorbid chronic conditions, mental health diagnoses, and psychosocial stressors alongside HIV. The quality of their care has often been affected by stigma, minority stress, and the quality of the patient-provider relationship and associated collaborations over treatment approaches and goals, which has a direct effect on outcomes. OBJECTIVE: At San Francisco VA Health Care System, the Infectious Disease Care and Resilience (IDCaRe) team was established to improve outcomes for Veterans with acute needs or persistent difficulties in care delivery and efficacy. METHOD: A five-step model to address complex needs in HIV care was adapted from existing literature and evidence base, combined with a culturally-aligned, interdisciplinary care orientation. This model was implemented with patients determined to be at high-risk for poor health engagement. A representative composite case study demonstrates the process. RESULTS: Three Veterans underwent the intervention with results presented. Lessons learned and future discussions are also discussed. CONCLUSION: The IDCaRe model has promise as an integrated, patient-centered, behaviorally-grounded intervention for improving HIV-related care outcomes for Veterans with complex needs.