Abstract

Background: The Veterans Health Administration (VA) is prioritizing employee well-being due to crisis levels of clinician burnout and turnover. The VA aims to achieve this by becoming a “Best Place to Work” while deliver- ing high quality, safe and equitable care to Veterans using learning health system (LHS) and high reliability or- ganization (HRO) principles. The National Academy of Medicine (NAM) has proposed organizations create supportive learning environments to improve workforce well-being. However, there is no one-size-fits all solu- tion. While the VA has invested in system level well-being efforts, including the Reduce Employee Burnout and Optimize Organizational Thriving (REBOOT) initiative, there is little guidance for teams on how to create sup- portive learning environments. To fill this gap, we developed The Relational Playbook. The Playbook consists of research-based resources and 50 evidence-based interventions for nurse managers to implement to change their team cultures including how to create joy in work and address difficult relationships. To support managers implementing the Playbook, we propose leadership coaching as a novel implementation strategy. Significance: The significance of this project is the potential to provide frontline managers with resources and research-based tools to create supportive learning environments that enhance employee well-being. Addition- ally, the study will contribute to the fields of implementation, LHS and HRO science and the VA efforts to en- hance employee well-being and reduce burnout and turnover (2023 VA HSR&D research priorities). Innovation and Impact: The proposed research is innovative in that it attempts to shift the current paradigm for the creation of supportive learning environments from an organization-level focus to the team level – where Veterans receive care. We will partner with VA cardiac catheterization laboratories (CCLs) as a model LHS for this work. We aim to implement and establish the feasibility and acceptability of the Relational Playbook inter- vention combined with leadership coaching. Our hypothesis is that enhanced leadership coaching will be a more feasible and acceptable approach to support Playbook implementation and the cultivation of supportive learning environments than standard implementation support. Specific Aims: Aim 1: Test the implementation, feasibility and acceptability of the Playbook intervention, coach- ing strategy, and study procedures. The VA Collaborative Evaluation Center (VACE), an independent group of mixed methods experts, will collect the feasibility and acceptability measures developed by Weiner et al. and select Reach, Effectiveness, Adoption, Implementation and Maintenance (REAIM) measures. Aim 2: Conduct a mixed methods process evaluation of intervention implementation. VACE will collect inter- view data to understand 1) intervention adaptations, ease of use, engagement, usefulness, and 2) implementa- tion speed, costs, barriers, facilitators, and unintended consequences. Methodology: We propose a pilot, site randomized trial design with an embedded mixed methods process eval- uation. We have enrolled 6 CCLs and will collect staff and unit level data using surveys and interviews at base- line, 6 and 12 months. All 6 sites will implement the Playbook. CCLs will be randomized to enhanced leader- ship coaching implementation support (n=3) or standard implementation support (n=3). The enhanced imple- mentation group will receive 6 months of virtual leadership coaching support. The standard implementation group will receive logistical support, but no advisement or coaching. Next steps: The study findings will 1) establish the feasibility and acceptability of the Playbook intervention combined with a leadership coaching implementation strategy, and 2) inform the design of a pragmatic adap- tive effectiveness trial. This trial will test the impact of the Playbook and coaching on employee well-being and factors that contribute to employee burnout, which is a new VA research priority area.

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DRA: Cardiovascular Disease

DRE: TRL - Applied/Translational, Treatment - Implementation

Keywords: Provider Performance Measures, Quality of Care, Safety Measurement Development

MeSH Terms: None at this time.