Category: Military and Veterans Affairs; Complementary Integrative Rehabilitation Medicine; Health Services Research
Objective :
The VA Whole Health (WH) Initiative is a redesign of health care delivery that focuses on administering personalized Veteran health plans rather than focusing on treating disease. In 2018, WH launched at 36 VA facilities: 18 flagship sites implement the full WH system and 18 design sites implement elements of WH and/or expand existing efforts. The purpose of this project was to identify potential barriers and facilitators to improve implementation efforts for this national initiative, and inform the expanded implementation of WH into specialty care, such as rehabilitation and long-term care.
Design : This evaluation project analyzed qualitative semi-structured interview data for participants. Rapid analysis using Consolidated Framework for Implementation Research Constructs (CFIR) was used to identify preliminary themes and topics.
Setting : Frontline staff and WH leadership were recruited from 5 design sites and 1 flagship site.
Participants (or Animals, Specimens, Cadavers) : 45 participants from the design sites and the flagship site participated in semi-structured interviews designed to elicit perceptions on the value of WH veteran health care delivery. Perceived facilitators and barriers toward the implementation of the WH program delivery model was assessed, along with leadership support and obtaining the resources needed for Veteran and staff participation.
Interventions : Not applicable.
Main Outcome Measure(s) : This qualitative programmatic implementation identified contextual and facilitating factors and barriers to determine influences on the WH implementation efforts.
Results :
Findings from the project indicated variation at each facility including: The provision of leadership support and resources for WH implementation, the need to improve administrative issues and the need for measures to be developed and used at the sites to measure WH outcomes.
Conclusions :
The WH initiative is a complex and a comprehensive endeavor that must be far reaching across the system to support cultural transformation of a whole-person oriented healing environment. Providers, clinicians, and leadership across sites were engaged and motivated to implement the WH care delivery model. Although facilitators (e.g., facility leadership endorsement, facility culture and resources) were identified, barriers (e.g. lack of facility resources, hiring and training mechanisms, leadership endorsement) prohibit optimal implementation and present numerous issues and prevent full implementation of the program. WH is a transformation priority within the VA and the motivation and readiness of VA employees are the foundation for creating cultural transformation in turning the Veterans Health Administration into a whole-person oriented healing environment.
Maisha Standifer
– Health Science Specialist, James A Haley Veterans Hospital, Tampa, FloridaJulie McMahon-Grenz
– Occupational Therapist, James A. Haley Hospital, Tampa, Florida.jpg "Bridget Cotner photo")
Bridget Cotner
– Health Science Specialist, James A Haley Veterans Hospital, Tampa, Florida
Christine Melillo
– Health Science Specialist, James A. Haley Veterans Hospital, Tampa, FloridaJacquelyn Paykel
– Whole Health Service, Director, James A Haley Veterans Hospital, Tampa, Florida
Jolie Haun
– Director of Implementation & Dissemination, James A. Haley Veterans Hospital, Tampa, Florida