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BACKGROUND: While health systems researchers have advanced conceptual thinking about the meaning of “resilience”, specific suggestions regarding how systems can become more resilient remain scarce. Moreover, additional work is needed on strategies for developing a resilience-oriented workforce responsive to public healthcare needs during crisis. This study seeks to fill this evidence gap through consideration of a new program recently launched at the Veterans Health Administration (VA) called Clinical Resource Hubs (CRHs). CRHs provide contingency staffing for primary care and mental health services, using predominantly telehealth modalities in 18 regional networks. Drawing upon insights from organizational theory, we describe how CRH resources (e.g., additional primary care providers with telehealth expertise) were leveraged during the early days of COVID-19 to deliver patient care and workforce training and support, and key factors that facilitated these responses. We hypothesize that having flexible contingency providers and staff who specialize in telehealth modalities may increase a health system's resilience (e.g., ability to absorb shocks), while also providing needed contingency care during non-crisis times. METHODS: We conducted semi-structured interviews with CRH directors and national program leaders (n=26) and used a rapid analysis approach to identify actions taken by CRHs to support the resiliency of the VA healthcare system during the pandemic. RESULTS: Respondents reported that almost all CRHs assisted with VA's COVID-19 response by maintaining patient access to care during the pandemic. This was accomplished by providing virtual and in-person contingency staffing for outpatient and inpatient care and triage support in VA clinical settings and the private sector. For example, respondents described how CRHs provided virtual outpatient staffing coverage for primary care providers and nurses reassigned to hospitals during the surge;virtual coverage for inpatient units in social work and pharmacy;and virtual triage for nurse advice lines. In addition, respondents reported that CRHs provided workforce support through training, coaching, and care delivery. Finally, respondents discussed key factors that facilitated CRHs' ability to quickly respond to the pandemic which included hub staff expertise in telehealth and increased acceptability of virtual care among key stakeholders. CONCLUSIONS: We found that the CRH program was flexible and nimble enough to respond to the demands of COVID-19. Having contingent staffing adept at virtual modes of care enabled VA health system resiliency during a public health crisis. As a multi-function program, CRHs may be a model for other similarly resourced healthcare organizations for supporting day-to-day operations through virtual staffing solutions, which can be redirected to meet human resource needs during shocks.
RESUMO
BACKGROUND: The COVID-19 pandemic drove burnout and turnover among healthcare workers (HCWs), but working environments may have differentially buffered or exacerbated the pandemic's effects. Primary care HCWs faced pandemic-related challenges, like changes in staffing and space requirements, and a rapid shift to telehealth care. HCWs who were engaged at their workplace may have had better well-being, despite these challenges. Our aims were to measure the prevalence of burnout and turnover intent among HCWs in VA primary care during the COVID-19 pandemic and;(2) to understand the association between individual-level burnout, turnover intent, and employee engagement, and facility-level COVID-19 burden, prior year burnout, and telehealth. METHODS: We obtained data on burnout, turnover intent, employee engagement, and individual demographics from the 2020 VA All Employee Survey (AES) for 19,909 primary care HCWs (providers;registered nurses;clinical associates;administrative associates) in 141 facilities. We linked these data at the facility-level to burnout from the 2019 AES, COVID test and death rates from the 2020 VA COVID Shared Data Resource, the proportion of telehealth primary care visits from the 2020 VA Corporate Data Warehouse, and facility complexity levels from the 2020 VHA Support Service Center. We modeled relationships between burnout, turnover intent, employee engagement, demographics, and facility-level characteristics using logistic regressions with standard errors clustered by facility. RESULTS: Thirty-seven percent of primary care HCWs reported burnout, and 31% reported their intent to leave their job within two years. From March to September 2020, by facility average, COVID tests were 56.5 per 1000 unique patients, COVID deaths were 0.46 per 1000 unique patients, and approximately 29% of primary care visits were conducted by phone, video, or other telehealth medium. Highly engaged employees were less likely to be burned out (odds ratio [OR] 0.29;95% confidence interval [CI] 0.28-0.33) and had a lower intention to leave their job (OR 0.35;95% CI 0.32-0.38). Greater than average facility-level burnout in 2019 was related to higher HCW burnout in 2020 (OR 8.19, 95% CI 2.11-31.82), but 2019 and 2020 turnover intent did not have similar relationship. High COVID tests and deaths, and telehealth measures were not associated with burnout or potential turnover. CONCLUSIONS: While COVID-19 burden and use of telehealth were not associated with worse primary care HCW burnout or turnover intent, our results suggest that interventions to improve employee engagement might mitigate both outcomes. Burnout and turnover intent were high, but similar to pre-pandemic levels, indicating the persistent influence of non-COVID drivers of these outcomes. Future research should focus on understanding elements of the working environment that contribute to burnout and turnover, and interventions should be developed to improve working environments, and therefore HCW well-being, in primary care.
RESUMO
Methods: We are fielding an online survey to approximately 2,000 Veterans using tele-WH services across 10 VHA facilities. The survey contains internally developed questions and validated patient-reported outcome measures (e.g., Perceived Stress Scale). Survey content was developed iteratively and refined based on Veteran feedback. The survey is collecting data on Veteran: (1) use of and interest in, (2) experiences and satisfaction with, (3) perceived outcomes of, and (4) sources of information about tele-WH services. Results: Data collection is underway. We will present data on the percent of respondents who: (1) used and (2) are interested in using each tele-WH service/therapy, (3) learned about tele-WH through various sources, (4) reported satisfaction with tele-WH services/therapies, and (5) reported that tele-WH participation helped them improve outcomes. We will use multivariate analyses to identify factors independently associated with use of tele-WH services and therapies, interest in future use, and perceived impacts on outcomes. Background: The Veterans Health Administration's (VHA) transformation into a 'Whole Health system of care' (WHS) has encompassed a shift in organizational culture, wherein care delivery is focused on Veteran goals and preferences rather than diagnoses alone. VHA's WHS includes offering commensurate services and therapies to Veterans, including complementary and integrative health services. In the wake of COVID-19, VHA rapidly shifted service delivery to a virtual format. For most Whole Health programs, the virtual format (i.e., 'tele-Whole Health' (tele-WH)) was a novel delivery platform. Our goal was to assess Veteran experiences with and perceptions of tele-WH services. Conclusion: Following the pandemic-related shift in services, interest in tele-WH continues to rise. Our data will provide insights regarding Veteran perceptions of tele-WH, including interest in continued use of tele-WH offerings and factors that can be addressed to facilitate participation. Such information can be used by healthcare institutions to plan future availability of tele-WH services.