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CDA 17-163 – HSR&D Study

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CDA 17-163
Building Supportive Learning Environments: Implementation Research in VA Cardiac Cath Labs
Heather Marie Gilmartin PhD NP BSN
Aurora, CO
Funding Period: January 2020 - December 2024


Background: The Veterans Health Administration (VA) has set a goal to become a learning health system to ensure the consistent delivery of high-quality, safe care to Veterans. A learning health system, per the Institute of Medicine, harnesses data and analytics to learn from every patient and feed the knowledge to clinicians to implement with high-reliability. Transforming the VA into a learning health system is vital to Veterans health, given the wide variation in use of evidence-based practices and Veteran outcomes. The learning environments in which clinical care is provided can impact these variations. Learning environments are the educational ap- proaches (e.g., on-line v. unit-based trainings), cultural context, and settings in which teaching, and learning happen. Supportive learning environments, which are the ideal learning environment, engage employees through team-based trainings, such as Crew Resource Management, that include communication and team- work skills and employ highly-reliable work practices (e.g., checklists). Healthcare teams need flexible training tools that can be easily implemented using available resources to create supportive learning environments. Until this need is met, one-size fits all approaches will be the dominant educational method in healthcare. Significance/Impact: The proposed research is significant for its potential to provide teams tailored Crew Re- source Management tools to create supportive learning environments, resulting in enhanced employee en- gagement, learning, and Veteran care and its contribution to implementation and learning health science. Innovation: The proposed research is innovative in that it attempts to shift the current paradigm for learning from standardized procedurally-focused educational methods that lack communication and teamwork content to one that provides teams Crew Resource Management tools to change their culture toward learning to en- hance Veteran care. We will partner with VA cardiac cath labs as a model learning health system for this work. Specific Aims: Aim 1: Assess how and why VA cath lab learning environments differ. Administer learn- ing environment surveys to the 81 VA cath labs, assess for changes over time and if learning environments that are highly supportive are associated with higher employee engagement and safety climate scores. Ob- serve two consistently supportive and two non-supportive learning environments to understand the basis for diverse contexts. Aim 2: Adapt Crew Resource Management to the culture, work flow, and learning envi- ronments of cath labs. Engage advisory panel and stakeholders using nominal, small group technique to achieve consensus on program design and toolkit components. Assess feasibility, appropriateness, acceptabil- ity of toolkit. Aim 3: Pilot test the Crew Resource Management-based toolkit at four cath labs over 1 year. Test the feasibility of implementation and collection of evaluation (e.g., adoption, implementation, mainte- nance) and outcome data (e.g., learning environment, teamwork, and error reporting). Using pre-post interven- tion data, test the hypothesis that as learning environments become more supportive, there will be a positive trend in employee engagement, safety climate, and a negative trend in cath lab errors. Methodology: We will use a mixed methods sequential explanatory design and partner with staff and leader- ship from the 81 VA cath labs for the proposed research. Next Steps: The study findings will be the basis for future work to spread and scale up Crew Resource Man- agement-based toolkits in diverse settings and populations and to study the impact on Veteran outcomes.

NIH Reporter Project Information:


Journal Articles

  1. Gilmartin HM, Saint S, Ratz D, Chrouser K, Fowler KE, Greene MT. The influence of hospital leadership support on burnout, psychological safety, and safety climate for US infection preventionists during the coronavirus disease 2019 (COVID-19) pandemic. Infection control and hospital epidemiology. 2024 Mar 1; 45(3):310-315.
  2. Kelley L, Broadfoot K, McCreight M, Wills A, Leonard C, Connelly B, Gilmartin H, Burke RE. Implementation and Evaluation of a Training Curriculum for Experienced Nurses in Care Coordination: The VA Rural Transitions Nurse Training Program. Journal of nursing care quality. 2023 Jul 1; 38(3):286-292.
  3. Gilmartin HM, Plomondon ME, Mueller C, Connelly B, Battaglia C, Waldo SW, Doll J. The Impacts of COVID-19 on Veterans Affairs Catheterization Laboratory Staff During the First Months of the US Response. The Journal of cardiovascular nursing. 2021 Nov 1; 36(6):595-598.
  4. Germack H, Cary M, Gilmartin H, Girouard S, Jones TM, Martin BJ, Norful AA, Anusiewicz CV, Riman KA, Schlak AE, Squires A, Estrada LV, Gazarian P, Gerchow L, Ghazal LV, Henderson MD, Mitha S, Mpundu G, Nikpour J, Royster M, Thompson R, Stolldorf DP. Leading Policy and Practice Change During Unprecedented Times: The Nursing Health Services Research Response. Journal of nursing regulation. 2021 Jul 8; 12(2):56-60.
  5. Reese SM, Gilmartin H, Smathers S. Challenges and opportunities in recruiting, hiring and training infection preventionists across facility settings. American journal of infection control. 2021 Aug 1; 49(8):973-977.
  6. Gilmartin H, Smathers S, Reese SM. Infection preventionist retention and professional development strategies: Insights from a national survey. American journal of infection control. 2021 Jul 1; 49(7):960-962.
  7. Mody L, Akinboyo IC, Babcock HM, Bischoff WE, Cheng VC, Chiotos K, Claeys KC, Coffey KC, Diekema DJ, Donskey CJ, Ellingson KD, Gilmartin HM, Gohil SK, Harris AD, Keller SC, Klein EY, Krein SL, Kwon JH, Lauring AS, Livorsi DJ, Lofgren ET, Merrill K, Milstone AM, Monsees EA, Morgan DJ, Perri LP, Pfeiffer CD, Rock C, Saint S, Sickbert-Bennett E, Skelton F, Suda KJ, Talbot TR, Vaughn VM, Weber DJ, Wiemken TL, Yassin MH, Ziegler MJ, Anderson DJ, SHEA Research Committee. Coronavirus disease 2019 (COVID-19) research agenda for healthcare epidemiology. Infection control and hospital epidemiology. 2022 Feb 1; 43(2):156-166.
  8. Gilmartin H, Reese SM, Smathers S. Recruitment and hiring practices in United States infection prevention and control departments: Results of a national survey. American journal of infection control. 2021 Jan 1; 49(1):70-74.
  9. Stolldorf D, Germack HD, Harrison J, Riman K, Brom H, Cary M, Gilmartin H, Jones T, Norful A, Squires A. Health Equity Research in Nursing and Midwifery: Time to Expand Our Work. Journal of nursing regulation. 2020 Jul 15; 11(2):51-61.
  10. Gilmartin HM, Hess E, Mueller C, Plomondon ME, Waldo SW, Battaglia C. A pilot study to assess the learning environment and use of reliability enhancing work practices in VHA cardiac catheterization laboratories. Learning health systems. 2021 Apr 1; 5(2):e10227.
  11. Greene MT, Gilmartin HM, Saint S. Psychological safety and infection prevention practices: Results from a national survey. American journal of infection control. 2020 Jan 1; 48(1):2-6.
Journal Other

  1. Gilmartin HM, Liu VX, Burke RE. Web Exclusive. Annals for Hospitalists Inpatient Notes - The Role of Hospitalists in the Creation of Learning Healthcare Systems. Annals of internal medicine. 2020 Jan 21; 172(2):HO2-HO3.

DRA: Health Systems, Cardiovascular Disease
DRE: TRL - Applied/Translational, Technology Development and Assessment
Keywords: Organizational Planning
MeSH Terms: None at this time.

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