A pilot study to assess the learning environment and use of reliability enhancing work practices in VHA cardiac catheterization laboratories

Developing a relational playbook for cardiology teams to cultivate supportive learning environments, enhance clinician well-being, and veteran care

Introduction

Despite the Veterans Health Administration (VA) efforts to become a learning health system (LHS) and high-reliability organization (HRO), interventions to build supportive learning environments within teams are not reliably implemented, contributing to high levels of burnout, turnover, and variation in care. Supportive learning environments build capabilities for teaching and learning, empower teams to safely trial and adapt new things, and adopt highly reliable work practices (eg, debriefs). Innovative approaches to create supportive learning environments are needed to advance LHS and HRO theory and research into practice.

Methods

To guide the identification of evidence-based interventions that cultivate supportive learning environments, the authors used a longitudinal, mixed-methods design and LHS and HRO frameworks. We partnered with the 81 VA cardiac catheterization laboratories and conducted surveys, interviews, and literature reviews that informed a Relational Playbook for Cardiology Teams.

Results

The Relational Playbook resources and 50 evidence-based interventions are organized into five LHS and HRO-guided chapters: Create a positive culture, teamwork, leading teams, joy in work, communication, and high reliability. The interventions are designed for managers to integrate into existing meetings or trainings to cultivate supportive learning environments.

Conclusions

LHS and HRO frameworks describe how organizations can continually learn and deliver nearly error-free services. The Playbook resources and interventions translate LHS and HRO frameworks for real-world implementation by healthcare managers. This work will cultivate supportive learning environments, employee well-being, and Veteran safety while providing insights into LHS and HRO theory, research, and practice.

The use and role of digital technology in learning health systems: A scoping review

OBJECTIVE

The review aimed to identify which digital technologies are proposed or used within learning health systems (LHS) and to analyze the extent to which they support learning processes in LHS.

MATERIALS AND METHODS

Multiple databases and grey literature were searched with terms related to LHS. Manual searches and backward searches of reference lists were also undertaken. The review considered publications from 2007 to 2022. Records focusing on LHS, referring to one or more digital technologies, and describing how at least one digital technology could be used in LHS were included.

RESULTS

2046 records were screened for inclusion and 154 records were included in the analysis. Twenty categories of digital technology were identified. The two most common ones across records were data recording and processing and electronic health records. Digital technology was primarily leveraged to support data access and aggregation and data analysis, two of the seven recognized learning processes within LHS learning cycles.

DISCUSSION

The results of the review show that a wide array of digital technologies is being leveraged to support learning cycles within LHS. Nevertheless, an over-reliance on a narrow set of technologies supporting knowledge discovery, a lack of direct evaluation of digital technologies and ambiguity in technology descriptions are hindering the realization of the LHS vision.

CONCLUSION

Future LHS research and initiatives should aim to integrate digital technology to support practice change and impact evaluation. The use of recognized evaluation methods for health information technology and more detailed descriptions of proposed technologies are also recommended.

How the VA is training the Next‐Generation workforce for learning health systems

Objectives

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Results

Conclusions