Leadership and Organizational Change Learning Network Hub Site

Veterans Admin Palo Alto Health Care Sys, Palo Alto CA

Investigators

Abstract

National efforts to increase implementation of innovative and evidence-based practices in VA mental health systems have been disappointing. Studies have identified a number of barriers to their implementation, including organization-level barriers and lack of leadership support. There is a need for implementation strategies to foster strong leadership for organizational change, to support VA’s strategic priorities to improve leadership competence and to function as a Learning Healthcare System. The Leadership and Organizational Change for Implementation (LOCI) is an implementation strategy that trains and works with leaders across organizational levels to improve organizational climate and promote activities associated with improved care. LOCI was adapted specifically for VA with input from a group of partners from the Office of Mental Health and Suicide Prevention VISN and facility mental health leads, as well as therapists and leaders from VA mental health settings, and considerable demand has been expressed for bringing LOCI into the VA. The Learning Network Hub will have two key goals: (1) to successfully implement a Train the Training (TTT) Program to build capacity to train and support LOCI and (2) to implement the LOCI training program within VA to support the uptake and increased reach of evidence-based practices and interventions (EBPs). To build internal capacity to conduct LOCI training, by Year 3, the LOCI developers will use a “see one, do one, teach one” approach, supplemented with simulation, to train and develop VA LOCI trainers and coaches. In Year 1 the initial group of 5 VA LOCI trainers and coaches will observe the LOCI developers lead a workshop (“see one”) and will co- lead the post-training coaching for the first cohort of 12 VA program leaders (from 6 facilities). During this first year, LOCI materials will continue to be refined for the VA, with a goal to have a fully developed training manual for trainers and an updated coaching manual. These activities will serve to: 1) train and prepare LOCI facilitators within the VA system, 2) pilot and refine LOCI in VA mental health programs, and 3) identify and prepare potential future LOCI coaches among the first facilities and programs. Year 2 will focus on conducting LOCI workshops and coaching with VA program leaders and expanding coaching capacity. VA trainers will lead the LOCI workshops and coaching for the next wave of VA Mental Health Program Leads (“do one”), with observation, support, and fidelity assessment from LOCI developers. The original 5 VA coaches will train an additional 3 coaches with guidance from the LOCI developers. Sixteen VA employees/program leads in 8 facilities will participate in the LOCI training program. Year 3 will focus on achieving independence from the LOCI developers and promoting further spread. VA LOCI facilitators will lead the LOCI workshops with support and LOCI fidelity assessment from the LOCI developers. The VA LOCI Trainers who were trained in Year 1 will train an additional 7 coaches, who will co-lead coaching calls with them. At the end of Year 3, 5 VA LOCI trainers/coaches and at least 10 additional LOCI coaches will be fully trained and 68 VA mental health program leaders will have completed the LOCI training program as they change organizational context to improve the reach and quality of evidence-based practices and Gold Status Programs at their facilities. Additional mentoring will be provided to Gold Status Fellows and research teams that implement LOCI to support important VA initiatives. The Hub will also provide online LOCI tools and resources with a message on a Teams site. Mixed methods will be used to evaluate the Hub’s impacts on program levels of implementation leadership, implementation climate, and use of practices that reflect scientific evidence and delivery system priorities. The Learning Network Hub team includes the LOCI developers and VA investigators with expertise in implementation science, effectiveness research, health services, organizational change, and mixed methods program evaluation. It supports key VA strategic priorities, including functioning as a Learning Healthcare System, increasing leadership competence, and access to evidence-based mental health care.