Abstract
The Whole Health Initiative is a redesign of health care delivery that focuses on administering personalized veteran health plans rather than focusing on treating disease. In 2018, Whole Health launched at 36 Veteran Affairs (VA) facilities throughout the country. Flagship sites (<em>N</em> = 18) implemented the full Whole health system and design sites (<em>N</em> = 18) implemented elements of Whole Health. The project purpose was to identify efforts to improve implementation for this national initiative to improve veterans’ lives. This evaluation project used a cross-sectional design to obtain qualitative semi-structured interview data. Rapid analysis using Consolidated Framework for Implementation Research Constructs (CFIR) was used to identify themes. A snowball sample of 45 staff participants from five design sites and one flagship site participated. Participants represented management and providers among other Whole Health staff. Facilities varied in the degree to which Whole Health was implemented. The provision of leadership support and resources, the need to address national policies and procedures and the need for standardized measures used to measure Whole Health outcomes were common experiences. Implementation of Whole Health to improve veterans’ lives is a complex endeavor. Providers, clinicians, and leadership are engaged and motivated to implement this new delivery model at their facilities, understanding it changes the focus of their relationships with veterans from one of focusing on problems to one of collaboratively working with veterans to achieve individual health goals. Identified barriers limit implementation and expose issues such as lack of facility resources, hiring and training mechanisms, and leadership endorsement. Whole Health is a priority within the VA and the motivation and readiness of VA staff to move into a more collaborative relationship with the veterans they serve are foundational to success and longevity of the program. Our findings created an opportunity to promote sustainable outcomes for future Whole Health implementation efforts.
Highlights
Complementary and integrative health (CIH) emphasizes self-care management and is the gold standard for improving patient experiences and optimizing health outcomes (Hibbard & Greene, 2013)
With 80% of veterans turning to CIH and nondrug therapy for pain relief (Goldsmith et al, 2020), the Veterans Health Administration (VHA) recognizes the need to respond in an evidence-based, proactive manner
In 2011, the VHA developed the Office of Patient Centered Care and Cultural Transformation (OPCC&CT) to promote and sustain a personalized, patient-driven, proactive approach to health care that focuses on optimizing veteran and family healing, health, and well- being (Krejci et al, 2014)
Summary
Complementary and integrative health (CIH) emphasizes self-care management and is the gold standard for improving patient experiences and optimizing health outcomes (Hibbard & Greene, 2013). CIH includes practices and products not typically encountered in Western medicine. Evidence suggests CIH is a viable approach to improve health outcomes (Elwy et al, 2020; Fan et al, 2017; Giannitrapani et al, 2019; Hartman et al, 2018; Millstine et al, 2017; Portella et al, 2020). Veteran participation in CIH decreases stress, improves physical and mental health functioning, and decreases pain (Donahue et al, 2020; Elwy et al, 2020). With 80% of veterans turning to CIH and nondrug therapy for pain relief (Goldsmith et al, 2020), the Veterans Health Administration (VHA) recognizes the need to respond in an evidence-based, proactive manner.
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