Leaning Into Whole Health: Sustaining System Transformation While Supporting Patients and Employees During COVID-19

Abstract

Background The US Veterans Health Administration (VA) is transforming its healthcare system to create a Whole Health System (WHS) of care. Akin to such reorganization efforts as creating patient-centered medical homes and primary care behavioral health integration, the WHS goes beyond by transforming the entire system to one that takes a proactive approach to support patient and employee health and wellness. The SARS-CoV-2 pandemic disrupted the VA’s healthcare system and added stress for staff and patients, creating an exogenous shock for this transformation towards a WHS. Objective We examined the relationship between VA’s WHS transformation and the pandemic to understand if transformation was sustained during crisis and contributed to VA’s response. Methods Qualitative interviews were conducted as part of a multi-year study of WHS transformation. A single multi-person interview was conducted with 61 WHS leaders at 18 VA Medical Centers, examining WH transformation and use during the pandemic. Data were analyzed using rapid directed content analysis. Results While the pandemic initially slowed transformation efforts, sites intentionally embraced a WH approach to support patients and employees during this crisis. Efforts included conducting patient wellness calls, and, for patients and employees, promoting complementary and integrative health therapies, self-care, and WH concepts to combat stress and support wellbeing. A surge in virtual technology use facilitated innovative delivery of complementary and integrative therapies and promoted continued use of WH activities. Conclusion The pandemic called attention to the need for healthcare systems to address the wellbeing of both patients and providers to sustain high quality care delivery. At a time of crisis, VA sites sustained WH transformation efforts, recognizing WH as one strategy to support patients and employees. This response indicates cultural transformation is taking hold, with WH serving as a promising approach for promoting wellbeing among patients and employees alike.

Training Interprofessional Staff in Whole Health Clinical Care at the Veterans Health Administration

“…Finally, it will be valuable to further explore how these active learning strategies can be incorporated when delivering WHS educational interventions virtually. 12 …”

Meeting the Needs of Rural Veterans: A Qualitative Evaluation of Whole Health Coaches’ Expanded Services and Support during COVID-19

“…The coronavirus (COVID-19) pandemic disrupted the traditional face-to-face delivery of VHA health and wellness programs [ 35 , 36 ]. While there is evidence demonstrating that Veterans in the VHA’s WH program experienced wide ranging biosocial impacts during the pandemic [ 8 ], there is a need for more understanding about how coaches attempted to meet the needs of Veterans residing in rural areas under conditions of COVID-19.…”

‘It Makes You Sit Back and Think Where You Wanna Go’: Veteran experiences in virtual whole health peer‐led groups

“…Adopting the Whole Health model, however, may be challenging for front‐line clinicians for a variety of individual‐ and system‐level factors 5,9,10 . Further, because the Whole Health model is at odds both with the conventional patient–clinician relationship and the traditional military hierarchy, this shift may also be difficult for Veterans.…”

“…7,8 Adopting the Whole Health model, however, may be challenging for front-line clinicians for a variety of individual-and system-level factors. 5,9,10 'recharge'), presented as the Circle of Health (Figure 1). Throughout the rest of the course, participants explore approaches to enhancing their well-being across these different dimensions, set SMART (specific, measurable, action-oriented, realistic and timed) goals 11 and draw on the group for support and accountability.…”

“…Adopting the Whole Health model, however, may be challenging for front‐line clinicians for a variety of individual‐ and system‐level factors. 5 , 9 , 10 Further, because the Whole Health model is at odds both with the conventional patient–clinician relationship and the traditional military hierarchy, this shift may also be difficult for Veterans. To facilitate Veteran comfort with the Whole Health model of care, VHA has designed the ‘Whole Health Pathway’, an entry point to Whole Health wherein Veterans learn about the core concepts of Whole Health and are empowered to actively engage in their own healthcare.…”