Garnering Support for Complementary and Integrative Health Implementation: A Qualitative Study of VA Healthcare Organization Leaders

Abstract

Objectives: Healthcare organization leaders' support is critical for successful implementation of new practices, including complementary and integrative health (CIH) therapies. Yet little is known about how to garner this support and what motivates leaders to support these therapies. We examined reasons leaders provided or withheld support for CIH therapy implementation, using a multilevel lens to understand motivations influenced by individual, interpersonal, organizational, and system determinants.Design and setting: We conducted qualitative interviews with leaders in seven Veterans Health Administration medical centers that offered at least three CIH therapies to Veterans and were identified as early adopters of CIH therapies.Subjects: Participants included 12 executive leaders and 34 leaders of key clinical services, including primary care, mental health, physical medicine and rehabilitation, and pain.Measures: We used a thematic analysis to examine leaders' narratives of barriers and facilitators to implementation including their attitudes toward CIH therapies, perceptions of evidence, engagement in implementation, and decisions to provide concrete support for CIH therapies. Drawing from Greenhalgh's Diffusion of Innovation framework, we organized themes according to the influence of individual determinants, two levels of inner setting, and outer system context on CIH implementation.Results: Leaders' decisions to provide or withhold support were driven by considerations across multiple levels including (1) individual attitudes/knowledge, perceptions of evidence, and personal experiences; (2) interpersonal interactions with trusted brokers, patients, and loved ones/colleagues/staff; (3) organizational concerns surrounding relative priorities, local resources, and metrics/quality/safety; and (4) system-level policy,

From patient outcomes to system change: Evaluating the impact of VHA's implementation of the Whole Health System of Care

“…Prior research in VA demonstrated the positive impact of CIH therapies such as yoga, Tai Chi, acupuncture, and mindfulness practices for Veterans, [13][14][15][16][17][18] yet the implementation of these services had up to that point been unsystematic and poorly coordinated overall. [19][20][21] In response, OPCC&CT formalized the WHS, and in October 2017, each Veterans Integrated Service Network (VISN -regional networks) identified and funded a WH flagship VA medical center for a 3-year WHS pilot. The evaluation was to culminate in April 2020 in a congressional report, including key findings on the pilot's impact on Veterans.…”

“…Moreover, it required an evaluation of the effect of CIH and other approaches on the health and well‐being of Veterans. Prior research in VA demonstrated the positive impact of CIH therapies such as yoga, Tai Chi, acupuncture, and mindfulness practices for Veterans, 13–18 yet the implementation of these services had up to that point been unsystematic and poorly coordinated overall 19–21 . In response, OPCC&CT formalized the WHS, and in October 2017, each Veterans Integrated Service Network (VISN ‐ regional networks) identified and funded a WH flagship VA medical center for a 3‐year WHS pilot.…”

Whole Health Use and Interest Across Veterans With Co-Occurring Chronic Pain and PTSD: An Examination of the 18 VA Medical Center Flagship Sites

“…Clinic leadership may have varied opinions on whether CIH interventions are effective, which may or may not be a barrier toward implementation. 46 Moreover, clinicians often must weigh available clinic resources with patient symptom severity and patient choice. By highlighting that patients will use these therapies if they are offered, the present data may encourage other healthcare settings and clinics to continue to expand their availability as these data demonstrate “If it is built, they will come.” In turn, engagement in these treatments can potentially improve targeted outcomes.…”