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Collier KM, Greene MT, Gilmartin HM, Fowler KE, Saint S. The role of spirituality, religiosity, and self-care on infection preventionist well-being: Results from a national survey in the United States. Am J Infect Control 2024; 52:726-730. [PMID: 38122935 DOI: 10.1016/j.ajic.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The degree to which religiosity, spirituality, and self-care practices can improve well-being among infection preventionists is not well understood. METHODS We surveyed infection preventionists from a random sample of United States hospitals in 2021. Multivariable logistic regression models were used to examine the associations between measures of spirituality, religiosity, and self-care and well-being. RESULTS Our response rate was 47% (415/881). A total of 49% of respondents reported burnout, 17% reported increased feelings of uncaring, and 69% would choose to become an infection preventionist again. Most respondents found importance in spiritual well-being (88%), religious beliefs (82%), and self-care practices (87%). Spiritual well-being was associated with increased odds of choosing to become an infection preventionist again (odds ratio = 2.32, 95% confidence interval = 1.19-4.53, P = .01). DISCUSSION Our national survey provides evidence that spiritual importance is associated with career satisfaction among infection preventionists. Our findings contribute to a general body of evidence suggesting spiritual importance may translate to higher flourishing and well-being via serving a higher purpose. CONCLUSIONS Promoting spiritual well-being may positively influence career satisfaction and overall well-being among infection preventionists.
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Affiliation(s)
- Kristin M Collier
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI.
| | - M Todd Greene
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; VA Ann Arbor Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Heather M Gilmartin
- Department of Health Systems, Management and Policy, University of Colorado, School of Public Health, Aurora, CO, USA; Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Veterans Health Administration Eastern Colorado Healthcare System, Aurora, CO
| | - Karen E Fowler
- VA Ann Arbor Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Sanjay Saint
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; VA Ann Arbor Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
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Schult TM, Mohr DC, Greenfield RH, Reddy KP. The Impact of Involvement in Whole Health System for Veterans or Participating in It for Oneself on Job Attitudes in VA Employees. J Occup Environ Med 2024; 66:e131-e136. [PMID: 38588074 DOI: 10.1097/jom.0000000000003062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
OBJECTIVE The aim of the study is to examine how involvement in the Whole Health System of care, clinically and personally (through employee-focused activities), would affect employee satisfaction, engagement, burnout, and turnover intent in the Veterans Health Administration. METHODS Multivariate logistic regression analysis of cross-sectional survey from Veterans Health Administration employees was used to determine the influence of Whole Health System involvement and Employee Whole Health participation on job attitudes. RESULTS Whole Health System involvement was associated higher job satisfaction, higher levels of engagement, lower burnout, and lower turnover intent. A similar pattern of results was identified when looking specifically at Employee Whole Health participation and associated job attitudes. CONCLUSIONS Employees who are either directly involved in delivering Whole Health services to veterans or who have participated in Whole Health programming for their own benefit may experience a meaningful positive impact on their well-being and how they experience the workplace.
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Affiliation(s)
- Tamara M Schult
- From the Veterans Health Administration, Office of Patient Centered Care and Cultural Transformation, Washington, DC (T.M.S., R.H.G., K.P.R.); Veterans Health Administration, National Center for Organization Development, Cincinnati, Ohio (D.C.M.); and Washington University School of Medicine, St Louis, Missouri (K.P.R.)
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Gilmartin HM, Connelly B, Hess E, Mueller C, Plomondon ME, Waldo SW, Battaglia C. Developing a relational playbook for cardiology teams to cultivate supportive learning environments, enhance clinician well-being, and veteran care. Learn Health Syst 2024; 8:e10383. [PMID: 38633018 PMCID: PMC11019383 DOI: 10.1002/lrh2.10383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/13/2023] [Accepted: 07/21/2023] [Indexed: 04/19/2024] Open
Abstract
Introduction Despite the Veterans Health Administration (VA) efforts to become a learning health system (LHS) and high-reliability organization (HRO), interventions to build supportive learning environments within teams are not reliably implemented, contributing to high levels of burnout, turnover, and variation in care. Supportive learning environments build capabilities for teaching and learning, empower teams to safely trial and adapt new things, and adopt highly reliable work practices (eg, debriefs). Innovative approaches to create supportive learning environments are needed to advance LHS and HRO theory and research into practice. Methods To guide the identification of evidence-based interventions that cultivate supportive learning environments, the authors used a longitudinal, mixed-methods design and LHS and HRO frameworks. We partnered with the 81 VA cardiac catheterization laboratories and conducted surveys, interviews, and literature reviews that informed a Relational Playbook for Cardiology Teams. Results The Relational Playbook resources and 50 evidence-based interventions are organized into five LHS and HRO-guided chapters: Create a positive culture, teamwork, leading teams, joy in work, communication, and high reliability. The interventions are designed for managers to integrate into existing meetings or trainings to cultivate supportive learning environments. Conclusions LHS and HRO frameworks describe how organizations can continually learn and deliver nearly error-free services. The Playbook resources and interventions translate LHS and HRO frameworks for real-world implementation by healthcare managers. This work will cultivate supportive learning environments, employee well-being, and Veteran safety while providing insights into LHS and HRO theory, research, and practice.
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Affiliation(s)
- Heather M. Gilmartin
- Denver/Seattle Center of Innovation for Veteran‐Centered and Value Driven CareVHA Eastern Colorado Healthcare SystemAuroraColoradoUSA
- Department of Health Systems Management and PolicyUniversity of Colorado, School of Public HealthAuroraColoradoUSA
| | - Brigid Connelly
- Denver/Seattle Center of Innovation for Veteran‐Centered and Value Driven CareVHA Eastern Colorado Healthcare SystemAuroraColoradoUSA
| | - Edward Hess
- Denver/Seattle Center of Innovation for Veteran‐Centered and Value Driven CareVHA Eastern Colorado Healthcare SystemAuroraColoradoUSA
| | - Candice Mueller
- CART Program, Office of Quality and Patient SafetyVeterans Health AdministrationWashingtonDCUSA
| | - Mary E. Plomondon
- Department of Health Systems Management and PolicyUniversity of Colorado, School of Public HealthAuroraColoradoUSA
- CART Program, Office of Quality and Patient SafetyVeterans Health AdministrationWashingtonDCUSA
| | - Stephen W. Waldo
- CART Program, Office of Quality and Patient SafetyVeterans Health AdministrationWashingtonDCUSA
- Department of Medicine, Division of CardiologyUniversity of ColoradoAuroraColoradoUSA
| | - Catherine Battaglia
- Denver/Seattle Center of Innovation for Veteran‐Centered and Value Driven CareVHA Eastern Colorado Healthcare SystemAuroraColoradoUSA
- Department of Health Systems Management and PolicyUniversity of Colorado, School of Public HealthAuroraColoradoUSA
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Gao G, Vaclavik L, Jeffery AD, Koch EC, Schafer K, Cimiotti JP, Pathak N, Duva I, Martin CL, Simpson RL. Developing a Quality Improvement Implementation Taxonomy for Organizational Employee Wellness Initiatives. Appl Clin Inform 2024; 15:26-33. [PMID: 38198827 PMCID: PMC10781573 DOI: 10.1055/s-0043-1777455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/07/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Standardized taxonomies (STs) facilitate knowledge representation and semantic interoperability within health care provision and research. However, a gap exists in capturing knowledge representation to classify, quantify, qualify, and codify the intersection of evidence and quality improvement (QI) implementation. This interprofessional case report leverages a novel semantic and ontological approach to bridge this gap. OBJECTIVES This report had two objectives. First, it aimed to synthesize implementation barrier and facilitator data from employee wellness QI initiatives across Veteran Affairs health care systems through a semantic and ontological approach. Second, it introduced an original framework of this use-case-based taxonomy on implementation barriers and facilitators within a QI process. METHODS We synthesized terms from combined datasets of all-site implementation barriers and facilitators through QI cause-and-effect analysis and qualitative thematic analysis. We developed the Quality Improvement and Implementation Taxonomy (QIIT) classification scheme to categorize synthesized terms and structure. This framework employed a semantic and ontological approach. It was built upon existing terms and models from the QI Plan, Do, Study, Act phases, the Consolidated Framework for Implementation Research domains, and the fishbone cause-and-effect categories. RESULTS The QIIT followed a hierarchical and relational classification scheme. Its taxonomy was linked to four QI Phases, five Implementing Domains, and six Conceptual Determinants modified by customizable Descriptors and Binary or Likert Attribute Scales. CONCLUSION This case report introduces a novel approach to standardize the process and taxonomy to describe evidence translation to QI implementation barriers and facilitators. This classification scheme reduces redundancy and allows semantic agreements on concepts and ontological knowledge representation. Integrating existing taxonomies and models enhances the efficiency of reusing well-developed taxonomies and relationship modeling among constructs. Ultimately, employing STs helps generate comparable and sharable QI evaluations for forecast, leading to sustainable implementation with clinically informed innovative solutions.
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Affiliation(s)
- Grace Gao
- Veteran Affairs Quality Scholars Program, Joseph Maxwell Cleland Atlanta VA Medical Center, Atlanta, Georgia, United States
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States
- School of Nursing, St Catherine University, St Paul, Minnesota, United States
| | - Lindsay Vaclavik
- Department of Internal Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, Texas, United States
| | - Alvin D. Jeffery
- Office of Nursing Services, Tennessee Valley Healthcare System, Nashville, Tennessee, United States
- Vanderbilt University School of Nursing, Nashville, Tennessee, United States
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Erica C. Koch
- Veteran Affairs Quality Scholars Program, Tennessee Valley VA Healthcare System, Nashville, Tennessee, United States, Clinical Instructor of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
- Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
| | - Katherine Schafer
- Veteran Affairs Quality Scholars Program, Tennessee Valley VA Healthcare System, Nashville, Tennessee, United States, Clinical Instructor of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
| | - Jeannie P. Cimiotti
- Veteran Affairs Quality Scholars Program, Joseph Maxwell Cleland Atlanta VA Medical Center, Atlanta, Georgia, United States
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States
| | - Neha Pathak
- Veteran Affairs Quality Scholars Program, Joseph Maxwell Cleland Atlanta VA Medical Center, Atlanta, Georgia, United States
| | - Ingrid Duva
- Veteran Affairs Quality Scholars Program, Joseph Maxwell Cleland Atlanta VA Medical Center, Atlanta, Georgia, United States
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States
| | - Christie L. Martin
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, United States
| | - Roy L. Simpson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States
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Locke A. Using the Values of Integrative Medicine to Create the Future of Healthcare. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2024; 13:27536130241253607. [PMID: 38751850 PMCID: PMC11095182 DOI: 10.1177/27536130241253607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/25/2024] [Accepted: 04/19/2024] [Indexed: 05/18/2024]
Abstract
The ideal future state of health for the world's populations requires a cohesive model that considers the synergistic roles of communities, public health and healthcare. This future state reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic and lifestyle approaches, healthcare professionals and disciplines to achieve optimal health and healing. This is the definition of Integrative Medicine. We are far from this idealistic future. Healthcare costs continue to escalate while life expectancy declines. We train our future healthcare professionals in our current disease-based model that prioritizes siloed pharmaceutical and interventional approaches over whole person prevention focused care. As healthcare professionals, we disregard our capacity to influence the leading risk factors for disease-related death and disability which include health behaviors, social, economic and environmental drivers. Burnout is high and rising. Rapid shifts are expected in the coming years as the current system's cost becomes untenable. We need a sustainable future for healthcare. That means we must figure out how to re-center on the patient, on a full spectrum of prevention and treatment, and how to influence public and community health. The future model must focus on health behaviors at its foundation, use systems thinking, be environmentally sustainable, and approach health from a population lens. The future will require an ability to consider complex systems approaches to health and wellbeing that include a focus on both the patient and the healthcare team. Research strategies must not only consider effectiveness but also reach, implementation and institutionalization in a multi-dimensional capacity that looks at whole person health as an outcome while looking at individuals in the context of where they live and work. The Integrative Medicine community has an opportunity to help lead the way to a sustainable and health focused future.
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Affiliation(s)
- Amy Locke
- Osher Center for Integrative Health, Spencer Fox Eccles School of Medicine, University of Utah, Nutrition and Integrative Physiology, College of Health, University of Utah Health, Academic Consortium for Integrative Medicine and Health, Salt Lake City, UT, USA
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Wu J, Bolton RE, Anwar C, Bokhour BG, Khanna A, Mullur RS, Taylor SL, Hyde J. Modifying Whole Health Services for Successful Telehealth Delivery: Lessons from Veterans Health Administration's Rapid Transition During the COVID-19 Pandemic. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:792-804. [PMID: 37668607 DOI: 10.1089/jicm.2023.0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
Introduction: The Veterans Health Administration (VHA) is shifting care from a disease-oriented to health-creating approach that aims to provide whole person care. This Whole Health (WH) system combines person-centered care with delivery of WH services (e.g., health coaching, well-being education and skill-building classes, and evidence-based complementary and integrative health therapies), alongside conventional medical services. During the COVID-19 pandemic, WH services were modified for delivery through telehealth (teleWH). This article characterizes modifications to WH services made to maintain continuity during the transition to telehealth formats. Materials and methods: We conducted semistructured qualitative interviews with a purposive sample of 51 providers delivering teleWH services at 10 VHA medical centers. We examined WH service modifications as well as facilitators and barriers to those modifications using rapid coding and directed content analysis. Results: Modifications were driven by (1) preparing for teleWH service delivery and (2) improving teleWH service delivery. To prepare for teleWH services, modifications were prompted by access, readiness, and setting and resources. Modifications to improve the delivery of teleWH services were motivated by engagement, community-building, safety, and content for a teleWH environment. One-on-one teleWH services required the fewest modifications, while more significant modifications were needed for well-being, skill-building, and movement-based groups, and reconfiguration of manual therapies. Discussion: Findings highlighted the need for modifications to ensure that teleWH services are accessible and safe and support interpersonal relationships between patients and providers, as well as in group-based classes. Successfully delivering teleWH services requires proactive preparation that considers access, readiness, and the availability of resources to engage in teleWH services. Tailoring strategies and considering the unique needs of different teleWH services are critical. Conclusions: The COVID-19 pandemic catalyzed teleWH service implementation, utilization, and sustainment. The challenges faced and modifications made during this transition provide lessons learned for other health care systems as they attempt to implement teleWH services.
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Affiliation(s)
- Juliet Wu
- U.S. Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Rendelle E Bolton
- U.S. Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Chitra Anwar
- U.S. Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Barbara G Bokhour
- U.S. Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Aishwarya Khanna
- U.S. Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Rashmi S Mullur
- U.S. Department of Veterans Affairs, Center for the Study of Health Care Innovation, Implementation & Policy (CSHIIP), Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA
- Department of Medicine, Division of Diabetes, Endocrinology & Metabolism, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Integrative Medicine Collaborative, University of California Los Angeles Health, Los Angeles, CA, USA
| | - Stephanie L Taylor
- U.S. Department of Veterans Affairs, Center for the Study of Health Care Innovation, Implementation & Policy (CSHIIP), Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Health Policy and Management, School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Justeen Hyde
- U.S. Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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Kligler B, Khung M, Schult T, Whitehead A. What We Have Learned About the Implementation of Whole Health in the Veterans Administration. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:774-780. [PMID: 36445191 DOI: 10.1089/jicm.2022.0753] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
As we have advanced the concept of Whole Health (WH) in the Veterans Administration over the past 10 years, we have had the unique advantage of working in a health care system in which a wide range of WH services-ranging from acupuncture to coaching to yoga and Tai Chi to nutrition classes to peer-facilitated empowerment and skill-building groups-are fully covered by the system as part of standard medical benefits. This has given us the opportunity to evaluate both the process and the outcomes of offering this type of Whole Person care on a system-wide scale. This article will review some of the lessons learned from that ongoing evaluation process in the areas of integration of complementary/integrative health approaches as well as health coaching and peer-led groups, WH education, employee well-being, cost impacts, and whole-system transformation. This is not a systematic review, as we will touch on numerous questions and lessons learned rather than dive deeply into the literature seeking the answer to one narrower question. Hopefully the narrative review approach taken here will stimulate further discussion in the field regarding what we are learning and what we can continue to learn from this large scale innovation.
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Affiliation(s)
- Benjamin Kligler
- Office of Patient Centered Care and Cultural Transformation, Veterans Health Administration, Washington, DC, USA
- Department of Family and Community Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maureen Khung
- Office of Patient Centered Care and Cultural Transformation, Veterans Health Administration, Washington, DC, USA
| | - Tamara Schult
- Office of Patient Centered Care and Cultural Transformation, Veterans Health Administration, Washington, DC, USA
| | - Alison Whitehead
- Office of Patient Centered Care and Cultural Transformation, Veterans Health Administration, Washington, DC, USA
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FISCELLA KEVIN, EPSTEIN RONALDM. The Profound Implications of the Meaning of Health for Health Care and Health Equity. Milbank Q 2023; 101:675-699. [PMID: 37343061 PMCID: PMC10509522 DOI: 10.1111/1468-0009.12660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/24/2023] [Accepted: 06/06/2023] [Indexed: 06/23/2023] Open
Abstract
Policy Points The meaning of health in health care remains poorly defined, defaulting to a narrow, biomedical disease model. A national dialogue could create a consensus regarding a holistic and humanized definition of health that promotes health care transformation and health equity. Key steps for operationalizing a holistic meaning of health in health care include national leadership by federal agencies, intersectoral collaborations that include diverse communities, organizational and cultural change in medical education, and implementation of high-quality primary care. The 2023 report by the National Academies of Sciences, Engineering, and Medicine on achieving whole health offers recommendations for action.
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Adjognon OL, Cohen-Bearak A, Kaitz J, Bokhour BG, Chatelain L, Charns MP, Mohr DC. Factors affecting the implementation of employee whole health in the veterans health administration: a qualitative evaluation. BMC Health Serv Res 2023; 23:600. [PMID: 37291554 DOI: 10.1186/s12913-023-09450-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 04/26/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND There is increasing recognition of the need to focus on the health and well-being of healthcare employees given high rates of burnout and turnover. Employee wellness programs are effective at addressing these issues; however, participation in these programs is often a challenge and requires large scale organizational transformation. The Veterans Health Administration (VA) has begun to roll out their own employee wellness program-Employee Whole Health (EWH)-focused on the holistic needs of all employees. This evaluation's goal was to use the Lean Enterprise Transformation (LET) model for organizational transformation to identify key factors-facilitators and barriers-affecting the implementation of VA EWH. METHODS This cross-sectional qualitative evaluation based on the action research model reflects on the organizational implementation of EWH. Semi-structured 60-minute phone interviews were conducted in February-April 2021 with 27 key informants (e.g., EWH coordinator, wellness/occupational health staff) knowledgeable about EWH implementation across 10 VA medical centers. Operational partner provided a list of potential participants, eligible because of their involvement in EWH implementation at their site. The interview guide was informed by the LET model. Interviews were recorded and professionally transcribed. Constant comparative review with a combination of a priori coding based on the model and emergent thematic analysis was used to identify themes from transcripts. Matrix analysis and rapid turnaround qualitative methods were used to identify cross-site factors to EWH implementation. RESULTS Eight common factors in the conceptual model were found to facilitate and/or hinder EWH implementation efforts: [1] EWH initiatives, [2] multilevel leadership support, [3] alignment, [4] integration, [5] employee engagement, [6] communication, [7] staffing, and [8] culture. An emergent factor was [9] the impact of the COVID-19 pandemic on EWH implementation. CONCLUSIONS As VA expands its EWH cultural transformation nationwide, evaluation findings can (a) enable existing programs to address known implementation barriers, and (b) inform new sites to capitalize on known facilitators, anticipate and address barriers, and leverage evaluation recommendations through concerted implementation at the organization, process, and employee levels to jump-start their EWH program implementation.
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Affiliation(s)
- Omonyêlé L Adjognon
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Adena Cohen-Bearak
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System , Bedford, MA, USA
| | | | - Barbara G Bokhour
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System , Bedford, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Leslie Chatelain
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
| | - Martin P Charns
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - David C Mohr
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA.
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA.
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Rogers CJ, Elchert CR, Hackney ME. Chiropractic Management of a 67-Year-Old Veteran With Chronic Low Back Pain Utilizing Low-Velocity Flexion-Distraction: A Case Report. J Chiropr Med 2023; 22:157-163. [PMID: 37346235 PMCID: PMC10280086 DOI: 10.1016/j.jcm.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 06/23/2023] Open
Abstract
Objective The purpose of this case report was to describe the treatment of an older veteran with chronic low back pain, utilizing flexion-distraction as a primary intervention for management. Clinical Features A 67-year-old man with chronic low back pain for several decades presented to the chiropractic clinic for evaluation. He reported low back pain that extended into the right lower extremity intermittently. The patient's imaging demonstrated significant degenerative changes in the lumber spinal anatomy. He had never experienced chiropractic interventions or management for his condition. Intervention and Outcome A trial of conservative care with flexion-distraction was applied as a primary intervention for the management of chronic low back pain. Instrument-assisted soft-tissue mobilization and moist heat were also applied for interventions. Despite having no changes in outcome assessments, the patient reported an improvement in his condition, reduced use of pain medication, and increased mobility after 4 sessions over a 4-week period. Conclusion Flexion-distraction was a beneficial chiropractic approach to the management of an older veteran with chronic low back pain and intermittent lower extremity pain for several decades.
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Affiliation(s)
- Casey J. Rogers
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Health Care System, Birmingham, Alabama
- Birmingham VA Medical Center, Birmingham, Alabama
| | | | - Madeleine E. Hackney
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta VA Health Care System, Decatur, Georgia
- Department of Medicine, Division of Geriatrics & Gerontology, Emory University School of Medicine, Atlanta, Georgia
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11
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LeBeau K, Varma DS, Kreider CM, Castañeda G, Knecht C, Cowper Ripley D, Jia H, Hale-Gallardo J. Whole Health coaching to rural Veterans through telehealth: Advantages, gaps, and opportunities. Front Public Health 2023; 11:1057586. [PMID: 37050942 PMCID: PMC10083506 DOI: 10.3389/fpubh.2023.1057586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/06/2023] [Indexed: 03/29/2023] Open
Abstract
BackgroundThe Veterans Health Administration (VHA) is one of the largest providers of telehealth in the United States and continues to lead the way in transforming healthcare services. VHA has been implementing its Whole Health (WH) initiative since 2018, a proactive practice empowering patients to take charge of their health and well-being. A key facilitator of the WH initiative is the WH coach who partners with Veterans to achieve their health-related goals. A gap exists in the literature regarding the understanding of WH coaches’ use of telehealth to engage rural-residing Veterans. COVID-19 unexpectedly interrupted in-person VHA delivery of care, including WH coaching which primarily relied on in-person delivery and focused less on telehealth. During the pandemic, WH coaches had to adapt and integrate different modalities to engage their Veteran patients. We examined WH coaches’ approaches to extending coaching to rural Veterans via technology, emphasizing the advantages of telehealth, existing gaps in telehealth delivery, and opportunities for telehealth as a coaching modality.MethodsThis project was implemented as part of a larger mixed methods evaluation regarding WH coaching for rural Veterans; this manuscript presents the findings from the qualitative data from the larger study. The qualitative dataset is comprised of data collected using three different qualitative methods: four focus groups (n = 11; 3–4 participants per group), in-depth individual interviews (n = 9), and open-ended responses from a national web-based survey (n = 140). Focus group, in-depth interview, and open-ended survey data were collected sequentially and separately analyzed following each wave of data collection. Findings from the three analyses were then collaboratively merged, compared, reorganized, and refined by the evaluation team to create final themes.ResultsThree final themes that emerged from the merged data were: (1) Advantages of Telehealth; (2) Telehealth Gaps for Rural Veterans, and (3) Strategies for Bridging Telehealth Gaps. Themes explicate telehealth advantages, gaps, and opportunities for rural Veteran WH coaching.ConclusionFindings highlight that video telehealth alone is not sufficient for meeting the needs of rural Veterans. Digital technologies hold promise for equalizing health access gaps; however, both human factors and broadband infrastructure constraints continue to require WH coaches to use a mix of modalities in working with rural Veterans. To overcome challenges and bridge gaps, WH coaches should be ready to adopt a blended approach that integrates virtual, in-person, and lower-tech options.
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Affiliation(s)
- Kelsea LeBeau
- Veterans Rural Health Resource Center-Gainesville (VRHRC-GNV), Office of Rural Health, Veterans Health Administration, Gainesville, FL, United States
- *Correspondence: Kelsea LeBeau,
| | - Deepthi S. Varma
- Veterans Rural Health Resource Center-Gainesville (VRHRC-GNV), Office of Rural Health, Veterans Health Administration, Gainesville, FL, United States
- Department of Epidemiology, University of Florida, Gainesville, FL, United States
| | - Consuelo M. Kreider
- Department of Epidemiology, University of Florida, Gainesville, FL, United States
- Department of Occupational Therapy, University of Florida, Gainesville, FL, United States
| | - Gail Castañeda
- Veterans Rural Health Resource Center-Gainesville (VRHRC-GNV), Office of Rural Health, Veterans Health Administration, Gainesville, FL, United States
| | - Cheri Knecht
- Veterans Rural Health Resource Center-Gainesville (VRHRC-GNV), Office of Rural Health, Veterans Health Administration, Gainesville, FL, United States
| | - Diane Cowper Ripley
- Director Emeritus, GeoSpatial Outcomes Division, Office of Rural Health, Veterans Health Administration, Gainesville, FL, United States
| | - Huanguang Jia
- Department of Biostatistics, University of Florida, Gainesville, FL, United States
| | - J. Hale-Gallardo
- Veterans Rural Health Resource Center-Salt Lake City (VRHRC-SLC), Office of Rural Health, Veterans Health Administration, Salt Lake City, UT, United States
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12
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Findley PA, Wiener RC, Mitra S, Wang H, Shen C, Sambamoorthi U. Whole Health in Parts: Omissions from National Data Sets. Popul Health Manag 2023; 26:22-28. [PMID: 36799933 PMCID: PMC10081708 DOI: 10.1089/pop.2022.0197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Background: The Whole Health model is a holistic approach to facilitate whole health practices by addressing (1) the physical, mental, and social health of individuals and (2) associated support systems. Several national organizations such as the Institute for Healthcare Improvement's (IHI) Age-Friendly Health Systems (AFHS) movement and, the U.S. Department of Veterans Affairs have implemented whole health frameworks with many common elements and promoted whole health practice and skills. However, implementing a Whole Health model across communities and health systems will require evidence of effectiveness. Generating evidence on the effectiveness of the Whole Health model's effect on health outcomes requires data-driven intelligence. Methods: We identified the national public-use data sets that are most often used in health research with a machine-assisted literature search of PubMed and Scopus for peer-reviewed journal articles published from 2010 through the end of 2021, including preprints, using Python [3.7]. We then assessed if the 8 most commonly used datasets include variables associated with whole health. Results: The number of publications examining whole health has increased annually in the last decade, with more than 2800 publications in 2020 alone. Since 2010, 24,811 articles have been published using 1 of these data sets. However, we also found a lack of data (ie, data set includes all of the whole health variables) to examine whole health in national data sets. Conclusions: We support a call to expand data collection and standardization of critical measures of whole health.
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Affiliation(s)
| | - R. Constance Wiener
- Department of Dental Public Health and Professional Practice, West Virginia University, Morgantown, West Virginia, USA
| | - Sophie Mitra
- Department of Economics, Research Consortium on Disability, Fordham University, Bronx, New York, USA
| | - Hao Wang
- Department of Emergency Medicine, JPS Health Network, Integrative Emergency Services, Fort Worth, Texas, USA
| | - Chan Shen
- Department of Surgery, Penn State Cancer Institute, Hershey, Pennsylvania, USA
| | - Usha Sambamoorthi
- Department of Pharmacotherapy, College of Pharmacy, “Vashisht” Professor for Health Disparities, HEARD Scholar, Texas Center for Health Disparities, University of North Texas Health Science Center, Fort Worth, Texas, USA
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Westervelt K, Rose GL, Avery S, Celley A, Cho J, Donoghue R, Goodrich B. Employee Group Coaching Program for University and Hospital Employees During COVID-19: A Feasibility Study. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2023; 12:27536130231207856. [PMID: 37868691 PMCID: PMC10588399 DOI: 10.1177/27536130231207856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 09/18/2023] [Accepted: 09/26/2023] [Indexed: 10/24/2023]
Abstract
Background Workplace wellbeing programs can be beneficial but range widely in approach. A group coaching model offers numerous benefits. Objective To evaluate feasibility of group coaching for employees during COVID-19. Methods Employees (n = 29) at a university and university hospital underwent a 12-week group coaching program. Measurements of feasibility -- including enrollment, attendance at sessions goal attainment and satisfaction -- and exploratory outcomes including perceived physical and mental health and stress were administered at beginning, middle, and end of the program, plus 2 follow-ups. Results Twenty-six of the 29 program enrollees (96% women; 65% university employees) opted to complete surveys at 1 or more time points, and 9 individuals completed surveys at all 5 time points. Median attendance was 9 sessions. Participants opted to focus on movement, nutrition and mind/body goals and all participants reported making progress toward their goal during the program. Exploratory wellness outcomes showed meaningful improvements in perceived physical and mental health and reduced stress during the program, with return to near baseline 12 weeks after program completion. Perceptions of workplace wellness culture varied by employer. Conclusion Despite pandemic-related disruptions to life, work, and health, online group coaching is feasible and acceptable to participants. The program should be replicated to evaluate whether the improvements in exploratory wellness outcomes observed during the program are statistically significant. The apparent return to baseline levels by 24 weeks suggests that post-program maintenance support may be helpful.
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Affiliation(s)
- Karen Westervelt
- Osher Center for Integrative Health, University of Vermont, Burlington, VT, USA
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA
| | - Gail L. Rose
- Osher Center for Integrative Health, University of Vermont, Burlington, VT, USA
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Scott Avery
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA
| | - Alisha Celley
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA
| | - Josh Cho
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA
| | - Rory Donoghue
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA
| | - Brennan Goodrich
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA
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14
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Hale-Gallardo J, Kreider CM, Castañeda G, LeBeau K, Varma DS, Knecht C, Cowper Ripley D, Jia H. Meeting the Needs of Rural Veterans: A Qualitative Evaluation of Whole Health Coaches' Expanded Services and Support during COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13447. [PMID: 36294023 PMCID: PMC9602744 DOI: 10.3390/ijerph192013447] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/23/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
The purpose of this qualitative study was to explore perspectives of Whole Health (WH) coaches at the Veterans Health Administration (VHA) on meeting the needs of rural Veterans during the COVID-19 pandemic. The evaluation design employed a qualitative description approach, employing focus groups and in-depth interviews with a convenience sample of WH coaches across the VHA system. Fourteen coaches who work with rural Veterans participated in either one of three focus groups, individual interviews, or both. The focus group data and in-depth interviews were analyzed separately using thematic analysis, and findings were then merged to compare themes across both datasets. Four primary themes were identified: bridging social risk factors for rural Veterans, leveraging technology to stay connected with Veterans at-a-distance, redirecting Veterans to alternate modes of self-care, and maintaining flexibility in coaching role during COVID-19. One overarching theme was also identified following a post-hoc analysis driven by interdisciplinary team discussion: increased concerns for Veteran mental health during COVID-19. Coaches reported using a variety of strategies to respond to the wide-ranging needs of rural Veterans during the pandemic. Implications of findings for future research and practice are discussed.
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Affiliation(s)
- J Hale-Gallardo
- Veterans Rural Health Resource Center-Salt Lake City (VRHRC-SLC), Office of Rural Health, Veterans Health Administration, Salt Lake City, UT 84148, USA
| | - Consuelo M Kreider
- Veterans Rural Health Resource Center-Gainesville (VRHRC-GNV), Office of Rural Health, Veterans Health Administration, Gainesville, FL 32601, USA
- Department of Occupational Therapy, University of Florida, Gainesville, FL 32611, USA
| | - Gail Castañeda
- Veterans Rural Health Resource Center-Gainesville (VRHRC-GNV), Office of Rural Health, Veterans Health Administration, Gainesville, FL 32601, USA
| | - Kelsea LeBeau
- Veterans Rural Health Resource Center-Gainesville (VRHRC-GNV), Office of Rural Health, Veterans Health Administration, Gainesville, FL 32601, USA
| | - Deepthi S Varma
- Veterans Rural Health Resource Center-Gainesville (VRHRC-GNV), Office of Rural Health, Veterans Health Administration, Gainesville, FL 32601, USA
- Department of Epidemiology, University of Florida, Gainesville, FL 32611, USA
| | - Cheri Knecht
- Veterans Rural Health Resource Center-Gainesville (VRHRC-GNV), Office of Rural Health, Veterans Health Administration, Gainesville, FL 32601, USA
| | - Diane Cowper Ripley
- Veterans Rural Health Resource Center-Gainesville (VRHRC-GNV), Office of Rural Health, Veterans Health Administration, Gainesville, FL 32601, USA
| | - Huanguang Jia
- Department of Biostatistics, University of Florida, Gainesville, FL 32611, USA
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15
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Kligler B, Hyde J, Gantt C, Bokhour B. The Whole Health Transformation at the Veterans Health Administration: Moving From "What's the Matter With You?" to "What Matters to You?". Med Care 2022; 60:387-391. [PMID: 35283434 DOI: 10.1097/mlr.0000000000001706] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Veterans Health Administration is undergoing a system-wide transformation to a Whole Person/Whole Health approach to care. The Whole Health model of care is described including early outcome data on utilization and effectiveness. The paper describes the first 10 years of this transformation and provides lessons learned during that process regarding large-scale system change.
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Affiliation(s)
- Benjamin Kligler
- Office of Patient Centered Care & Cultural Transformation, Veterans Health Administration, Washington, DC
- Department of Family and Community Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Justeen Hyde
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System
- Department of General Internal Medicine, Boston University School of Medicine, Boston
| | - Cynthia Gantt
- Office of Patient Centered Care & Cultural Transformation, Veterans Health Administration, Washington, DC
| | - Barbara Bokhour
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System
- Department of General Internal Medicine, Boston University School of Medicine, Boston
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
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16
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Ametrano RM, McGillicuddy ML, Sanyal S, Topor DR. Training Interprofessional Staff in Whole Health Clinical Care at the Veterans Health Administration. Glob Adv Health Med 2022; 11:2164957X221092361. [PMID: 35433116 PMCID: PMC9008845 DOI: 10.1177/2164957x221092361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/15/2022] [Accepted: 03/21/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction The Veterans Health Administration (VHA) initiated a system-wide redesign in
2011 toward a patient-centered approach called the Whole Health System (WHS)
of care. Education of VHA clinical staff in WHS-informed care, Whole Health
Clinical Care (WHCC), is one critical element of this redesign effort. At a
minimum, WHCC education should address core competencies for clinicians and
be considered satisfactory for learners. This is the first study to evaluate
learner satisfaction and perceived achievement of course objectives in WHCC
that incorporated active learning strategies. Method A large VA Healthcare System developed an in-person workshop focused on WHCC
that used multiple active learning activities. These activities included
case presentations, role playing, experiential learning, and group
discussion. Results Sixty-two interprofessional staff attended the workshop in November 2019.
Forty (64.50%) participants completed post-workshop surveys within 30 days.
Data suggest participants were highly satisfied with the workshop and that
they successfully met stated learning objectives. Conclusions We call on VHA and private-sector hospitals to train clinical staff in WHCC
that incorporates use of active learning strategies.
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Shah F, Sells JR, Werthman J, Abraham C, Ali AM, Callaway-Lane C. A Multi-Site Evaluation of A National Employee Wellness Initiative at the Department of Veterans Affairs. Glob Adv Health Med 2022; 11:21649561211053805. [PMID: 35273830 PMCID: PMC8902194 DOI: 10.1177/21649561211053805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/24/2021] [Accepted: 09/29/2021] [Indexed: 11/16/2022] Open
Abstract
Background The Department of Veterans Affairs (VA) seeks to transform its health care
delivery from disease-centered, episodic care to a holistic and
patient-centered model known as the Whole Health System (WHS) of care.
Employee engagement and buy-in are crucial to this cultural transformation.
The VA aspires to provide employees with opportunities to experience whole
health in their personal and professional lives through a national Employee
Whole Health (EWH) program. Although there are national recommendations,
different local facilities may have unique strategies and challenges as they
implement this program. Objective This study aimed to conduct a program evaluation of EWH at three different VA
facilities across the United States in order to identify facilitators and
barriers to the implementation of EWH. Methods The team used the RE-AIM framework to develop an interview guide to assess
various domains of implementation. Quantitative data on whole health
offerings at each site were gauged using a national employee education
platform. Standardized employee-related metrics at each site were assessed
using the annual, national VA employee survey. Results EWH has had variable implementation at the three sites. Sites noted main
facilitators as employee interest as well as available skills and expertise
for delivering complementary and integrative care to employees. Limited
staffing for EWH and a lack of dedicated employee time were cited as
barriers. The infrastructure to perform local program evaluations to
demonstrate effectiveness and impact were missing. Conclusion Employee engagement in whole health activities has the potential to support
the VA’s mission to transform its health care delivery model. Currently, the
use of EWH and its potential impact are difficult to discern based on
available information. Local sites need guidance to conduct program
evaluations and find creative solutions to enhance employee participation. A
robust measurement system to demonstrate effectiveness is paramount to
ensure the success of this initiative.
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Affiliation(s)
- Freny Shah
- U.S. Department of Veterans Affairs, Atlanta VA Health Care System, Decatur, GA, USA
- Emory University School of Medicine, Atlanta, GA, USA
| | - Joanna R. Sells
- U.S. Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, CA, USA
- University of California, San Francisco, CA, USA
| | - Jennifer Werthman
- U.S. Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Corrine Abraham
- U.S. Department of Veterans Affairs, Atlanta VA Health Care System, Decatur, GA, USA
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA
| | - Asma M. Ali
- US Department of Veterans Affairs, Michael E. Debakey VA Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Carol Callaway-Lane
- U.S. Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN, USA
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