The Campaign For Inclusive Care

Program Overview

“The best chance for a wounded warrior to recover and thrive is having a strong, well-supported caregiver” – 2014 RAND Report

The Veterans Health Administration (VHA) is the largest integrated healthcare system in the country, serving more than nine million enrolled veterans annually and VHA healthcare providers are committed to the highest quality of care for our veterans. According to recent surveys, over 25% of VHA enrollees reported needing the support of a caregiver. These caregivers, the spouses, parents, family members and friends of veterans take on a variety of tasks including bathing, feeding, dressing, managing medical appointments, monitoring for emotional triggers, and more. They must also often manage households and take on the role of primary breadwinner.

Based on RAND research and collaborative work by the U.S. Department of Veterans’ Affairs (VA), the Elizabeth Dole Foundation and its coalition partners on the Military Caregiver Journey Map, one of the most vulnerable points for a veteran caregiver is the initial clinical visit with their veteran. Here, and along the healthcare journey, communication can often be a challenge between the clinician and the caregiver. This can set a tone for a stressful care relationship for the healthcare professional, the family caregiver, and the Veteran.

To combat this growing challenge, the Elizabeth Dole Foundation and the VA created the Campaign for Inclusive Care, a national initiative to integrate military and veteran caregivers into their veteran’s care team from day one of the care process. Together, the Foundation and the VA have committed to implementing this bold initiative in three Veteran Integrated Service Networks (VISNs) in the program’s pilot year.

To achieve a culture of inclusive care across the VHA, the Campaign is organized into three phases:

1) Understand the Challenges and Opportunities within the VHA landscape

2) Organize the Response by forming a Solutions Team of VHA clinicians, caregivers and system change experts to create a toolkit for addressing the changes necessary to achieve success

3) Establish The Academy for Inclusive Care, a curriculum and learning management system for VHA providers.

Each phase will be supported by the EDF team and overseen by an Advisory Board of VA, EDF staff and other curriculum, research and culture change experts.

 

Phase 1: Understand Challenges and Opportunities
In the first phase, Duke University healthcare system researchers will conduct in-depth interviews among roughly 30 healthcare providers (clinicians and social workers). The findings will be provided to key stakeholders in a report. A review of healthcare privacy regulations will also be undertaken to understand how these rules might factor into caregiver-provider interactions. These findings will ultimately inform the creation of the curriculum and deployment of the program.

Actions:

  1. Perform literature review of healthcare provider practices towards caregivers.
  2. Develop an interview guide for a range of different types of healthcare providers (e.g., physician, registered nurse, social worker).
  3. Administer interviews to a diverse group of VA healthcare providers (an estimated 30 providers to be interviewed)
  4. Prepare analysis of policies and practices related to confidentiality/privacy regulations that may influence healthcare provider engagement with caregivers.
  5. Form the advisory board consisting of EDF staff, VA staff, and key stakeholders to provide guidance and facilitate the ongoing work of the Campaign.
  6. Engage pilot VISNs and outreach to Solutions Team members
    1. Solutions Team will consist of healthcare providers from all three pilot VISNs in addition to caregivers and subject matter experts.

Deliverables:

  1. Report on findings and regulations written and shared with EDF, USAA, and VA.
  2. Solutions Team selected (20 healthcare providers, 5 subject matter experts, 5 caregivers).
  3. Advisory Board established, scope defined and quarterly meetings scheduled.

 

Phase 2: Organize the Response – Form the Solutions Team
With a baseline understanding of the challenges and opportunities related to healthcare provider practice, the project team will then engage a group of 30 healthcare providers, subject matter experts (no more than 5) and 5 caregivers to form the Solutions Team. With the report findings in hand and an understanding of caregiver-provider interactions, the Solutions Team will explore how a culture of inclusive care could be attained and sustained within the VHA. The Solutions Team will deliver a Toolkit of best practices, based on their experience and the research findings, and share the methods they utilized to engage in culture change among healthcare providers.

Actions:

  1. Host a summit meeting with the Solutions Team and the Advisory Board to translate research into changes.
  2. Develop a toolkit for guidance on healthcare-provider interaction best practices and VA culture change.
    1. This toolkit, to be developed by the Solutions Team, will serve as the basis for the Learning Team’s development of the curriculum as well as the guiding materials for future Solutions Teams from VISNs who adopt the Campaign for Inclusive Care after the pilot year.
  3. Create a corresponding measurement strategy to assess whether changes are leading to improvements.
    1. Measures will include user download tracking, pre-and post-training program skills tests for providers and comparison caregiver surveys.

Deliverables:

  1. Kick-Off Event
  2. Toolkit for Change
  3. Measurement Strategy

 

Phase 3: Establish the Academy for Inclusive Care
In the third phase of the Campaign, members of the Solutions Teams and Learning Teams, EDF team, and the Advisory Board will develop the Academy of Inclusive Care. The Academy will focus on two deliverables. First, the execution of a Learning Management System (LMS) using content developed by the Solutions Team and the curriculum developed by the Learning Team. We anticipate that in year one, the LMS could be piloted and reach 300-500 healthcare providers with an introductory video on the concepts of the Campaign. Second, the Academy will serve as the virtual space to access the LMS, Toolkit and Research papers and within VISNs, the site where Solution Team members will gather to review application of the culture change lessons, share lessons learned and welcome new members onto the Solutions Team.

Actions:

  1. Establish the Academy for Inclusive Care. The Solutions Team will document and formalie their guide to culture change. The Learning Team will formalize three online curricula via 10 minute presentations and one interactive course.
  2. Create LMS for hosting online, videos, with capacity for CEUs, user tracking and custom signup links, capacity to manage 300 users, with capacity to scale to 50,000.
  3. Manage The Academy for Inclusive Care as it tests, measures and evaluates different methods to create culture change that is sustainable, flexible and scalable.
  4. Evaluate interventions (e.g. workshops, curriculum) as designed and implemented by the Solutions Team regarding change in healthcare provider practices.

    Deliverables:
    1. Academy for Inclusive Care established
    2. Learning Management System to include three online curricula and one interactive video

 

Measuring Success:

To know that the culture is changing within VHA, that caregivers are being included within their veteran’s medical teams and that healthcare providers feel empowered to do so, we must continually measure success of this initiative. Success will be measured in three key ways:

  • Tracking of provider downloads, logins and uses of the Academy for Inclusive Care
  • Pre-and post-training program skills assessments in Academy for Inclusive Care to providers to gauge effectiveness and impact
  • Surveys to caregivers engaging with providers receiving training under the Campaign for Inclusive Care and compare those to surveys of caregivers engaging with providers not receiving Campaign for Inclusive Care training.

A measurement of success–reaching and influencing healthcare providers to embrace a Culture of Inclusive Care–is by design a fluid number that will increase with each year of the Campaign. When 500 healthcare providers participate in the Academy, they will reach a total of approximately 125,000 caregivers, assuming each healthcare provider sees 1,000 patients annually; and of those patients, 25% are supported by caregivers. By repeating this cycle, one VISN at a time, the Campaign team will rapidly deploy upgrades via the Solutions Teams to participate in the Academy of Inclusive Care. Because the Campaign for Inclusive Care has been established based on research and best change management practices, a flexible and focused framework has been developed, which will support widespread scaling within the VHA and beyond.

Press Release: “The Elizabeth Dole Foundation, VA and USAA Launch New Alliance to Integrate Caregivers Into Veterans Medical Care