Building Supportive Learning Environments: Implementation Research in VA Cardiac Cath Labs

背景：退伍军人健康管理局（VA）已经设定了一个目标，成为一个学习卫生系统， 确保始终如一地为退伍军人提供高质量、安全的护理。一个学习健康系统，根据研究所 利用数据和分析从每位患者身上学习，并将知识提供给临床医生， 以高可靠性实现。将退伍军人事务部转变为一个学习型健康系统对退伍军人的健康至关重要， 鉴于循证实践和退伍军人结局的使用存在很大差异。学习环境 提供临床护理的时间会影响这些变化。学习环境是一种教育资源， 接近（例如，在线培训与单元培训）、文化背景以及教与学 发生支持性学习环境是理想的学习环境，能够吸引员工 通过基于团队的培训，如船员资源管理，包括沟通和团队， 工作技能和采用高度可靠的工作实践（例如，检查表）。医疗团队需要灵活的培训 可以利用现有资源轻松实施的工具，以创建支持性学习环境。 在满足这一需求之前，一刀切的方法将是医疗保健领域的主要教育方法。 意义/影响：拟议的研究是重要的，因为它有可能为团队提供量身定制的船员重新- 源管理工具，以创造支持性的学习环境，从而提高员工的EN- 学习和退伍军人护理及其对实施和学习健康科学的贡献。 创新：拟议的研究是创新的，因为它试图改变目前的学习范式 从缺乏沟通和团队合作内容的标准化、以程序为中心的教育方法 一个提供团队船员资源管理工具，以改变他们的文化，学习， hance退伍军人护理。我们将与VA心脏导管实验室合作，作为这项工作的示范学习卫生系统。 具体目标：目标1：评估VA导管室学习环境如何以及为何不同。管理学习- 对81个VA导管室进行环境调查，评估随时间的变化以及学习环境是否 高度支持的员工参与度和安全氛围得分较高。Ob- 提供两个持续支持和两个非支持性学习环境，以了解 不同的背景。目标2：使船员资源管理适应文化，工作流程和学习环境 导管室的基座。利用名义上的小组技术，让咨询小组和利益相关者参与， 就程序设计和工具包组件达成共识。评估可行性、适当性、可接受性- toolkit工具包目标3：在四个导管室对基于团队资源管理的工具包进行试点测试， 年测试实施和收集评价的可行性（例如，通过、执行、维持、 事件）和结果数据（例如，学习环境、团队合作和错误报告）。采用前后干预- 测试数据，测试假设，随着学习环境变得更加支持， 员工敬业度、安全氛围和导管室错误的负面趋势。 方法：我们将使用混合方法顺序解释性设计，并与员工和领导合作- 从81 VA导管室运送用于拟定研究。 下一步：研究结果将是未来工作的基础，以传播和扩大船员资源的人， 基于年龄的工具包在不同的环境和人群，并研究对退伍军人的结果的影响。

Background: The Veterans Health Administration (VA) has set a goal to become a learning health system to ensure the consistent delivery of high-quality, safe care to Veterans. A learning health system, per the Institute of Medicine, harnesses data and analytics to learn from every patient and feed the knowledge to clinicians to implement with high-reliability. Transforming the VA into a learning health system is vital to Veterans health, given the wide variation in use of evidence-based practices and Veteran outcomes. The learning environments in which clinical care is provided can impact these variations. Learning environments are the educational ap- proaches (e.g., on-line v. unit-based trainings), cultural context, and settings in which teaching, and learning happen. Supportive learning environments, which are the ideal learning environment, engage employees through team-based trainings, such as Crew Resource Management, that include communication and team- work skills and employ highly-reliable work practices (e.g., checklists). Healthcare teams need flexible training tools that can be easily implemented using available resources to create supportive learning environments. Until this need is met, one-size fits all approaches will be the dominant educational method in healthcare. Significance/Impact: The proposed research is significant for its potential to provide teams tailored Crew Re- source Management tools to create supportive learning environments, resulting in enhanced employee en- gagement, learning, and Veteran care and its contribution to implementation and learning health science. Innovation: The proposed research is innovative in that it attempts to shift the current paradigm for learning from standardized procedurally-focused educational methods that lack communication and teamwork content to one that provides teams Crew Resource Management tools to change their culture toward learning to en- hance Veteran care. We will partner with VA cardiac cath labs as a model learning health system for this work. Specific Aims: Aim 1: Assess how and why VA cath lab learning environments differ. Administer learn- ing environment surveys to the 81 VA cath labs, assess for changes over time and if learning environments that are highly supportive are associated with higher employee engagement and safety climate scores. Ob- serve two consistently supportive and two non-supportive learning environments to understand the basis for diverse contexts. Aim 2: Adapt Crew Resource Management to the culture, work flow, and learning envi- ronments of cath labs. Engage advisory panel and stakeholders using nominal, small group technique to achieve consensus on program design and toolkit components. Assess feasibility, appropriateness, acceptabil- ity of toolkit. Aim 3: Pilot test the Crew Resource Management-based toolkit at four cath labs over 1 year. Test the feasibility of implementation and collection of evaluation (e.g., adoption, implementation, mainte- nance) and outcome data (e.g., learning environment, teamwork, and error reporting). Using pre-post interven- tion data, test the hypothesis that as learning environments become more supportive, there will be a positive trend in employee engagement, safety climate, and a negative trend in cath lab errors. Methodology: We will use a mixed methods sequential explanatory design and partner with staff and leader- ship from the 81 VA cath labs for the proposed research. Next Steps: The study findings will be the basis for future work to spread and scale up Crew Resource Man- agement-based toolkits in diverse settings and populations and to study the impact on Veteran outcomes.