Relational Playbook Pilot Study
NCT Number: NCT06456021
Status: ACTIVE_NOT_RECRUITING
Study Type: INTERVENTIONAL
Phases: NA
Conditions: Health Workforce|Burnout
Interventions: BEHAVIORAL: The Relational Playbook|BEHAVIORAL: Leadership Coaching
Sponsor: VA Office of Research and Development
Sex: ALL
Age: CHILD, ADULT, OLDER_ADULT
Enrollment: 10
Study Design: Allocation: RANDOMIZED|Intervention Model: PARALLEL|Masking: NONE|Primary Purpose: HEALTH_SERVICES_RESEARCH
Start Date: 2024-07-01
Completion Date: 2025-12-31
Locations: Rocky Mountain Regional VA Medical Center, Aurora, CO, Aurora, Colorado, 80045-7211, United States

Summary:
Background: The Veterans Health Administration (VA) is prioritizing employee well-being due to crisis levels of clinician burnout and turnover. The VA aims to achieve this by becoming a "Best Place to Work" while delivering high quality, safe and equitable care to Veterans using learning health system (LHS) and high reliability organization (HRO) principles. The National Academy of Medicine (NAM) has proposed organizations create supportive learning environments to improve workforce well-being. However, there is no one-size-fits all solution. While the VA has invested in system level well-being efforts, including the Reduce Employee Burnout and Optimize Organizational Thriving (REBOOT) initiative, there is little guidance for teams on how to create supportive learning environments. To fill this gap, we developed The Relational Playbook. The Playbook consists of research-based resources and 50 evidence-based interventions for nurse managers to implement to change their team cultures including how to create joy in work and address difficult relationships. To support managers implementing the Playbook, the investigators propose leadership coaching as a novel implementation strategy.

Significance: The significance of this project is the potential to provide frontline managers with resources and research-based tools to create supportive learning environments that enhance employee well-being. Additionally, the study will contribute to the fields of implementation, LHS and HRO science and the VA efforts to enhance employee well-being and reduce burnout and turnover.

Innovation and Impact: The proposed research is innovative in that it attempts to shift the current model for the creation of supportive learning environments from an organization-level focus to the team level - where Veterans receive care. The investigators will partner with VA cardiac catheterization laboratories (CCLs) as a model LHS for this work. The investigators aim to implement and establish the feasibility and acceptability of the Relational Playbook intervention combined with leadership coaching. The hypothesis is that enhanced leadership coaching will be a more feasible and acceptable approach to support Playbook implementation and the cultivation of supportive learning environments than standard implementation support.

Specific Aims: Aim 1: Test the implementation, feasibility and acceptability of the Playbook intervention, coaching strategy, and study procedures. The VA Collaborative Evaluation Center (VACE), an independent group of mixed methods experts, will collect the feasibility and acceptability measures developed by Weiner et al. and select Reach, Effectiveness, Adoption, Implementation and Maintenance (REAIM) measures. Aim 2: Conduct a mixed methods process evaluation of intervention implementation. VACE will collect interview data to understand 1) intervention adaptations, ease of use, engagement, usefulness, and 2) implementation speed, costs, barriers, facilitators, and unintended consequences.

Methodology: The investigators propose a pilot, site randomized trial design with an embedded mixed methods process evaluation. The investigators have enrolled 6 CCLs and will collect staff and unit level data using surveys and interviews at baseline, 6 and 12 months. All 6 sites will implement the Playbook. CCLs will be randomized to enhanced leadership coaching implementation support (n=3) or standard implementation support (n=3). The enhanced implementation group will receive 6 months of virtual leadership coaching support. The standard implementation group will receive logistical support, but no advisement or coaching.

Next steps: The study findings will 1) establish the feasibility and acceptability of the Playbook intervention combined with a leadership coaching implementation strategy, and 2) inform the design of a pragmatic adaptive effectiveness trial. This trial will test the impact of the Playbook and coaching on employee well-being and factors that contribute to employee burnout, which is a new VA research priority area. This project is relevant to all aspects of VA healthcare for it will test the feasibility and acceptability of a novel Relational Playbook combined with a leadership coaching implementation strategy for frontline managers to cultivate supportive learning environments. This work will inform national efforts to enhance employee wellbeing due to crisis levels of employee burnout and turnover. The investigators will pilot the Playbook with 1:1 virtual leadership coaching to inspire nurse managers to improve their team culture. The investigators will conduct a mixed methods process evaluation to inform a pragmatic adaptive effectiveness trial. The investigators expect this study to demonstrate the Playbook combined with coaching is a feasible and acceptable approach to create supportive learning environments that improve employee well-being and address factors contributing to employee burnout and turnover.

Primary Outcome Measures: Feasibility as assessed by interviews and survey trends, At baseline, CCL managers will take the 64-item Learning Environment Survey (\>4-7 Likert) and 12-item Readiness to Change survey (\>4-5 Likert scale). At 6 months after Playbook implementation, CCL managers will be interviewed to understand progress on improvement goals. CCL managers will retake the 64-item Learning Environment Survey and a take the 15-item Acceptability, Appropriateness, Feasibility of Intervention Measures Survey (1-5 likert) to identify trends and changes over time. Feasibility is measured by survey trends in the Learning Environment survey, interview data, and responses to the Feasibility of Intervention Measures., 6 months|Acceptability as assessed by interviews and survey trends, At baseline, CCL managers will take the 64-item Learning Environment Survey (\>4-7 Likert) and 12-item Readiness to Change survey (\>4-5 Likert scale). At 6 months after Playbook implementation, CCL managers will be interviewed to understand progress on improvement goals. CCL managers will retake the 64-item Learning Environment Survey and a take the 15-item Acceptability, Appropriateness, Feasibility of Intervention Measures Survey (1-5 likert) to identify trends and changes over time. Acceptability is measured by survey trends in the Learning Environment survey, interview data, and responses to the Acceptability Measures., 6 months
Secondary Outcome Measures: Adoption/demand as assessed by number of interventions implemented and coaching attendance, For both Enhanced and Standard groups, adoption/demand will be measured by responses to the monthly Qualtrics survey reporting the number of required interventions they implemented that month (1-3 per chapter/month). For enhanced group, attendance at coaching sessions (min 5 over 6 months) will be collected., Monthly for the 6 months of Playbook implementation|Fidelity as assessed by reported adaptations, For both Enhanced and Standard groups, fidelity will be measured by responses to the monthly Qualtrics survey reporting any adaptations to the Playbook. For enhanced group, adaptations to NCOD GROW Coaching Model will be collected. Additional adaptation data will be collected during CCL manager interviews., Monthly for the 6 months of Playbook implementation|Ease of Use as assessed by ease of use rating, Ease of use is measured by asking CCL managers to rate Playbook ease of use and Coaching strategy ease of use in the Enhanced group during interviews., 6-9 months after Playbook implementation|Engagement as assessed by interview reactions, Engagement is measured using data from the CCL manager interviews of their reaction to Playbook interventions and reaction to coaching strategy., 6-9 months after Playbook implementation|Usefulness as assessed by usefulness ratings, Usefulness will be measured by asking about Playbook intervention usefulness ratings, Coaching strategy usefulness ratings, CCL manager growth + development during CCL manager inerviews., 6-9 months after Playbook implementation|Speed as assessed by number of days, Using data from Qualtrics surveys and interviews, measuring the number of days from Playbook received to 1st trial (7-28) and number of weeks for Playbook intervention adopted into practice (2-6)., Monthly for the 6 months of Playbook implementation|Cost as assessed by mean time/wage, Using interview and coaching data, measuring the CCL managers mean time/wage and Dr. Gilmartin (coach) mean time/wage., 6-9 months after Playbook implementation|Unintended Consequences as assessed by counting events/concerns/complaints, Tracking any adverse events, complaints, concerns (\<1 month)., Through study completion, an average of 1.5 years|Maintenance as assessed by the number of interventions sustained, Maintenance is measured by the number of Playbook interventions used at 1 year (At least 50% of those used at 6 months) collected by Qualtrics survey., 1 year after Playbook implementation