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.
This project is relevant to all aspects of VA healthcare for it will develop and evaluate a training toolkit to assist healthcare teams to change their culture toward learning to enhance Veteran care. This work will support the VA transformation to a learning health system, so clinicians can see every patient encounter as a way to make the next one better. This will be achieved through studying unit-level learning environments, identifying high- reliability practices that support a learning culture and using this knowledge to adapt a team training program to the culture and workflow of clinical units. We will develop and test a training toolkit to empower teams to de- velop their own culture of learning and a rigorous mixed methods evaluation that leads to valid, generalizable lessons applicable across healthcare settings. We expect this study to result in positive changes in learning environments, teamwork, and highly-reliable use of evidence-based practices. The findings will inform future studies to determine the impact of learning environments on Veteran outcomes.
