Promising Strategies to Support COVID-19 Vaccination of Healthcare Personnel: Insights from the VHA National Implementation

Abstract Background As of August 2021 up to 30% of Americans were uncertain about taking the COVID-19 vaccine. Some healthcare personnel (HCP) also delayed or declined vaccination. Objective Identify barriers and facilitators of Veterans Health Administration (VHA) HCP vaccination program Design: Key informant interviews with employee occupational health (EOH) providers Participants: 38 VHA EOH providers representing 26 of VHA’s regionally diverse healthcare systems. Approach: Thematic analysis elucidated 5 key themes, and specific strategies recommended by EOH Key Results: Implementation themes included: 1) Leverage diverse skillsets through multidisciplinary effort, specifically COVID-19 vaccination teams with clear goals/roles. 2) “Focus like a laser”: invest in processes and align resources with priorities, including specific strategies of: creating detailed processes, eg. logistics plan to prevent wastage and allocate excess vaccine doses; addressing time trade-offs for personnel involved in vaccine clinics by suspending everything non-essential; designating process/authority to shift personnel where needed; and proactively involving leaders to support resource allocation/alignment. 3) Expect and accommodate vaccine buy-in occurring over time, including specific strategies of: preparing for some HCP slow buy-in; aligning buy-in facilitation with identities and motivation; encouraging word-of-mouth and hyper-local testimonials. 4) Overcome misinformation through trustworthy communication, with specific strategies including: tailoring communication to individuals and addressing COVID vaccines “in every encounter”; leveraging proactive institutional messaging (e.g., townhalls, Q&As) to reinforce information; inviting bi-directional conversations about hesitancy. 5) Use existing and newly developed communication channels to foster sharing and learning across teams and sites, eg. a national VHA EOH listserv. Conclusions Expecting deliberation allows systems to prepare for complex distribution logistics, and conversations that are trustworthy, bi-directional, and identity-aligned - overall supporting mandate goals. Ideally, organizations 1) provide time for conversations about vaccines; those conversations would 2) address individual concerns and foster bi-directional shared decision-making, 3) be informed by identity-based motivation, and 4) delivered by identity-concordant individuals.

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National Implementation of Acute Stroke Care Centers in the Veterans Health Administration (VHA): Formative Evaluation of the Field Response

Journal of General Internal Medicine ◽

10.1007/s11606-014-3036-1 ◽

2014 ◽

Vol 29 (S4) ◽

pp. 845-852 ◽

Cited By ~ 5

Author(s):

Teresa M. Damush ◽

Kristine K. Miller ◽

Laurie Plue ◽

Arlene A. Schmid ◽

Laura Myers ◽

...

Keyword(s):

Acute Stroke ◽

Formative Evaluation ◽

Stroke Care ◽

Veterans Health Administration ◽

Veterans Health ◽

Health Administration ◽

Acute Stroke Care ◽

National Implementation ◽

Field Response

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COVID-19 Infections Among Healthcare Personnel in the United States Veterans Health Administration, March – August, 2020

Journal of Occupational and Environmental Medicine ◽

10.1097/jom.0000000000002109 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Gina Oda ◽

Aditya Sharma ◽

Cynthia Lucero-Obusan ◽

Patricia Schirmer ◽

Pooja Sohoni ◽

...

Keyword(s):

United States ◽

Veterans Health Administration ◽

The United States ◽

Healthcare Personnel ◽

Veterans Health ◽

Health Administration

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National Implementation of Evidence-based Bundles for Prevention of Device-associated Infections in Veterans Health Administration (VHA) Facilities

American Journal of Infection Control ◽

10.1016/j.ajic.2015.04.146 ◽

2015 ◽

Vol 43 (6) ◽

pp. S59

Author(s):

Marla Clifton ◽

Stephen Kralovic ◽

Loretta Simbartl ◽

Rachael Hasselbeck ◽

Tina Martin ◽

...

Keyword(s):

Veterans Health Administration ◽

Evidence Based ◽

Veterans Health ◽

Health Administration ◽

National Implementation

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Implementation of precision oncology in the Veterans Health Administration (VHA).

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.6507 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 6507-6507 ◽

Cited By ~ 3

Author(s):

Michael J. Kelley ◽

Jill Duffy ◽

Bradley J Hintze ◽

Christina D. Williams ◽

Neil L Spector

Keyword(s):

Clinical Trial ◽

Healthcare System ◽

Program Implementation ◽

Rural Areas ◽

Precision Oncology ◽

Veterans Health ◽

Health Administration ◽

National Implementation ◽

Sample Test ◽

Oncology Care

6507 Background: VHA is the US’s largest integrated healthcare system providing care to over 6 million Veterans (~40% in rural areas). Precision Oncology offers the promise of effective, low-toxicity targeted therapies tailored to individual tumor genomics but is unequally available to patients in the US. As part of the Cancer Moonshot, VHA is implementing a system-wide Precision Oncology Program (POP) including patients in rural areas, where specialty oncology care has historically had limited availability. Methods: Patients tested with multigene NGS tumor sequencing through 1 of 2 contracted vendors were identified from POP records and cancer characteristics were extracted from POP and medical records. Drug use data was obtained from the VA Corporate Data Warehouse. NGS testing results and annotations were extracted from POP records. Results: A total of 978 tumor samples were sent for NGS testing since program inception in 2015. The most common diagnoses are lung (464: adeno 314, squamous 107), GI (87), LN (75), liver (56), H&N (52), and prostate (43). The rate of sample test requests increased rapidly after national implementation in July 2016 (mean 23 samples/month prior to implementation to mean 126 samples/month 3 months later) as did the number of participating facilities (mean 8/month to 27/month). Sequencing success rate increased from 68% to 71% over the same interval while mean turn around time remained similar at 19.7 and 19.1 d, respectively. NGS results are available for a cohort of 344 patients including: lung 200 (adeno 138, squamous 51), skin 28, LN 20, liver 19, GI 16. 979 variants were found including TP53 278, KRAS 106, STK11, APC 38, PIK3CA 38, and CDKN2A 37. 228 patients had actionable results (on-label drug 24, off-label drug 165, clinical trial 213). To date, 8 patients received a recommended drug outside a clinical trial between 11 and 288 d after testing (median 82 d); 4 additional patients had received an NGS-recommended drug prior to testing. Conclusions: Implementation of tumor NGS testing as part of Precision Oncology Program in a US distributed healthcare system is feasible. Further program implementation and provision of appropriate targeted drugs both on and off study will be necessary to impact patient outcomes.

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Guidance for Selecting Health Care Products Using Human Factors Techniques

Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care ◽

10.1177/2327857918071029 ◽

2018 ◽

Vol 7 (1) ◽

pp. 117-120

Author(s):

Helen J. A. Fuller ◽

Timothy Arnold ◽

Tandi Bagian

Keyword(s):

Health Care ◽

Heuristic Evaluation ◽

Veterans Health ◽

Health Administration ◽

Purchasing Decisions ◽

Medical Products ◽

Trade Offs ◽

Hands On ◽

Available Information ◽

Product Literature

In health care, a wide variety of professionals use a wide variety of products when providing care to a wide variety of patients. In addition, safety reports support the idea that medical products vary in terms of usability, compatibility, and functionality. All this variability may contribute to purchasers failing to fully understand and define the needs for and risks of these products. Some purchasing decisions in the Veterans Health Administration (VHA) utilize well-defined procedures such as investigation by Integrated Product Teams (IPTs), which includes a hands-on evaluation of multiple options prior to crafting a national contract. Ideally, all products would go through rigorous functionality and usability testing under a variety of conditions prior to purchase, but such an approval process does not currently exist. The Purchasing Checklist aids purchasers in investigating patient safety concerns related to usability when planning a purchase when extensive hands-on evaluation is not possible. The checklist includes steps such as assembling a team that includes key representatives, considering the purchase needs and options, performing heuristic evaluation of the product literature and other available information, and documenting trade-offs to identify the best option.

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An Intervention With Meaning

Crisis ◽

10.1027/0227-5910/a000433 ◽

2017 ◽

Vol 38 (6) ◽

pp. 376-383 ◽

Cited By ~ 2

Author(s):

Brooke A. Levandowski ◽

Constance M. Cass ◽

Stephanie N. Miller ◽

Janet E. Kemp ◽

Kenneth R. Conner

Keyword(s):

High Risk ◽

Qualitative Methodology ◽

Veterans Health Administration ◽

Veterans Health ◽

Safety Planning ◽

Health Administration ◽

Suicide Method ◽

Treatment Providers ◽

Interactive Nature ◽

Behavioral Health Treatment

Abstract. Background: The Veterans Health Administration (VHA) health-care system utilizes a multilevel suicide prevention intervention that features the use of standardized safety plans with veterans considered to be at high risk for suicide. Aims: Little is known about clinician perceptions on the value of safety planning with veterans at high risk for suicide. Method: Audio-recorded interviews with 29 VHA behavioral health treatment providers in a southeastern city were transcribed and analyzed using qualitative methodology. Results: Clinical providers consider safety planning feasible, acceptable, and valuable to veterans at high risk for suicide owing to the collaborative and interactive nature of the intervention. Providers identified the types of veterans who easily engaged in safety planning and those who may experience more difficulty with the process. Conclusion: Additional research with VHA providers in other locations and with veteran consumers is needed.

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