1046 — Implementing Complementary and Integrative Health in VHA: The Critical Role of Hospital Leadership and Strategies for Engagement

Lead/Presenter: Rendelle Bolton, COIN - Bedford/Boston
All Authors: Bolton RE (VA Center for Healthcare Organization and Implementation Research; Center for Evaluating Patient-Centered Care in VA) Bokhour BG (VA Center for Healthcare Organization and Implementation Research; Center for Evaluating Patient-Centered Care in VA) Dvorin K (VA Center for Healthcare Organization and Implementation Research; Center for Evaluating Patient-Centered Care in VA) Elwy AR (VA Center for Healthcare Organization and Implementation Research; Center for Evaluating Patient-Centered Care in VA) Huynh A (VA Center for the Study of Healthcare Innovation, Implementation and Policy; Center for Evaluating Patient-Centered Care in VA) Taylor SL (VA Center for the Study of Healthcare Innovation, Implementation and Policy; Center for Evaluating Patient-Centered Care in VA)

Objectives:
VHA facilities are increasingly offering complementary and integrative health (CIH) therapies such as yoga, meditation, and acupuncture to address Veterans' health concerns, including chronic pain. Recent passage of the Comprehensive Addiction and Recovery Act (CARA) mandates VA to expand CIH offerings as part of an overarching strategy to respond to chronic pain and opiate addiction. Yet VHA facilities have historically encountered bureaucratic challenges in funding, hiring, licensure, resource provision, and space utilization when implementing CIH. Subsequently, understanding and obtaining leadership support may be critical to the implementation and success of CIH. This qualitative study examined the role of leadership in CIH implementation at 8 VHAs and identified strategies used to promote leadership engagement.

Methods:
We conducted semi-structured interviews with 55 hospital executives, clinical service line leaders, and CIH leaders at 8 VHAs across the country. We asked participants about their attitudes towards CIH; involvement in CIH implementation; barriers/facilitators to implementation; and sustainability of CIH at their facilities. Interview transcripts were analyzed using a priori and emergent content coding. Site summaries were created within categories and reviewed by a multidisciplinary study team using constant comparison methods.

Results:
Leadership played a key role in facilitating or stymying CIH implementation, with direct impacts on resource allocation, staffing, access, utilization, employee support, and sustainability. Support for CIH was affected by (1) attitudes towards CIH as an effective treatment, (2) perception of CIH as a mechanism to address local/national priorities, (3) competing fiscal and hospital priorities, and (4) concerns about liability, access, and logistical issues. We identified five types of strategies used to enhance leadership support: Communicating Evidence; Linking CIH to Priorities; Creating Organizational Structures to Support Implementation; Leveraging Pressure from Patients and VA Central Office; and Encouraging Personal Experience of CIH.

Implications:
Leadership support is critical to the success of CIH, which can be difficult to implement given bureaucratic barriers. CIH leaders can utilize five identified strategies to promote leadership buy-in, and enhance perceptions of CIH as a worthwhile investment to pursue.

Impacts:
CIH offers non-pharmaceutical options for pain management and is mandated by CARA. Enhancing leadership support will be crucial for successful uptake and spread of CIH therapies.