Evaluating a Whole Health Approach to Enhance Veteran Care: Exploring the Staff Experience
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 (N = 18) implemented the full Whole health system and design sites (N = 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.
Abstract: Introduction: Persistent inequities exist in obstetric and neonatal outcomes in military families despite universal health care coverage. Though the exact underlying cause has not been identified, social determinants of health may uniquely impact military families. The purpose of this study was to qualitatively investigate the potential impact of social determinants of health and the lived experiences of military individuals seeking maternity care in the Military Health System. Materials and methods: This was an Institutional Review Board-approved protocol. Nine providers conducted 31 semi-structured interviews with individuals who delivered within the last 5 years in the direct or purchased care market. Participants were recruited through social media blasts and clinic flyers with both maximum variation and homogenous sampling to ensure participation of diverse individuals. Data were coded and themes were identified using inductive qualitative research methods. Results: Three main themes were identified: Requirements of Military Life (with subthemes of pregnancy notification and privacy during care, role of pregnancy instructions and policies, and role of command support), Sociocultural Aspects of the Military Experience (with subthemes of pregnancy as a burden on colleagues and a career detractor, postpartum adjustment, balancing personal and professional requirements, pregnancy timing and parenting challenges, and importance of friendship and camaraderie in pregnancy), and Navigating the Healthcare Experience (including subthemes of transfer between military and civilian care and TRICARE challenges, perception of military care as inferior to civilian, and remote duty stations and international care). Conclusions: The unique stressors of military life act synergistically with the existing health care challenges, presenting opportunities for improvements in care. Such opportunities may include increased consistency of policies across services and commands. Increased access to group prenatal care and support groups, and increased assistance with navigating the health care system to improve care transitions were frequently requested changes by participants.