Lead/Presenter: Heather Gilmartin, COIN - Seattle/Denver
All Authors: Gilmartin HM (Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care), Connelly, B., Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care Hess, E. Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care Plomondon, M. CART Program, Office of Quality and Patient Safety, Veterans Health Administration Waldo, S. CART Program, Office of Quality and Patient Safety, Veterans Health Administration Battaglia, C. Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care
The Veterans Health Administration (VA) set a goal to become a learning health system and high reliability organization (LHS-HRO) to foster trust with Veterans and enhance employee well-being by delivering high-quality, safe, equitable care and the creation of a learning culture. Learning environments are the educational approaches, context and settings in which teaching, and learning happens and are fundamental to LHS-HROs. Supportive learning environments empower teams to trial, adapt and adopt innovations while using highly reliable practices (e.g., checklists) to ensure patient safety. It is unknown if supportive learning environments exist in the VA and what strategies create this environment within clinical teams. To fill this gap, we partnered with the 81 VA cardiac catheterization labs (CCLs) to identify supportive learning environments, assess their creation, the impact on staff, and the evidence-based strategies in use. These data and the literature will inform the creation of customized training tools to spread supportive learning environment best practices across CCLs.
Longitudinal, sequential, mixed methods explanatory design, guided by LHS-HRO frameworks. The Learning Environment Survey in VA CCLs was administered to VA staff in 2018 and 2020. Linear regression and Bayesian models were used to rank CCLs and to characterize relationships between learning environments and employee engagement, retention, and safety climate. Management and staff from high and mid-ranking CCLs were interviewed. Qualitative data were analyzed using matrix, content analysis. The training tool was developed from these data and literature reviews. Feedback, acceptability, appropriateness, and feasibility ratings (1-5 ascending Likert scale) were requested from an expert review panel.
The 2018 survey (N = 296; 68 CCLs; 84% response rate) detected national and CCL level (N = 29) variation that persisted through 2020 (N = 231; 67 CCLs; 83% response rate). Supportive learning environments were associated with higher employee engagement, retention, and safety climate. Interviews with 13 staff from 6 CCLs revealed five LHS-HRO concepts being used to create supportive learning environments: Create a positive culture, purposely build a team, lead the team, create joy in work, communicate effectively and use high reliability practices. CCLs best practices were collected and compared to the literature from the fields of positive psychology, appreciative inquiry, relational coordination, servant leadership, joy in work, the VA Whole Health Framework, and the VA Clinical Team Training Framework. A 250-page Relational Playbook for Cardiology Teams training tool was developed and rated high for acceptability (4.37/5), appropriateness (4.28/5) and feasibility (3.94/5).
The identification of supportive learning environments and the evidence-based strategies used by VA CCLs informed a novel intervention, a Relational Playbook for Cardiology teams training tool, that will be implemented and evaluated to assist CCLs to move their culture toward learning and high reliability.
The creation of a Relational Playbook training tool designed by and for CCL teams will provide clinical managers the tools and resources to integrate LHS-HRO best practices into daily care. This program of research has the potential to enhance Veteran care, employee well-being and inform the VA LHS-HRO journey.