S02 Attachment Twelve 12 Design Framework for Whole Health Implementation.pdf

FY19

Version 1: Feb2019 Attachment Twelve (12) – Design Framework for Whole Health Implementation 36C24821R0092

DESIGNATION FRAMEWORK FOR

WHOLE HEALTH IMPLEMENTATION

An organizational guide to Whole Health Transformation and Implementation of the VA Whole Health System

Ver1.Feb2019

EXECUTIVE SUMMARY

Begin with the end in mind. --Stephen Covey

The VA is committed to large-scale implementation of the Whole Health System (WHS). Delivering Whole Health is a key component of VHA Modernization efforts and is embedded within the Department of Veterans Affairs 2018-2024 Strategic Plan: “the VA will significantly improve Veteran health outcomes by shifting from a system primarily focused on disease management to one that is based on partnering with Veterans throughout their lives and focused on

Whole Health. VA will provide personalized, proactive, patient driven health care to empower, equip, and encourage Veterans to take charge of their health, well-being, and to adopt healthy living practices that deter or defer preventable health conditions.” The Designation Framework for Whole Health

Implementation was designed with a Veteran-driven system of care mindset to describe the future state when the Whole Health System is implemented and what will change from the site perspective and, even more importantly, from the Veteran perspective.

The Designation Framework for Whole Health Implementation addresses “Where are we going?” It describes desired outcomes along the four phases of the

Whole Health implementation journey. To achieve these outcomes, key milestone accomplishments have been identified and organized around seven domains: Governance, Operations, Pathway, Well-Being Program, Whole Health Clinical Care, Employee Whole Health, and Community Partnerships. It is

NOT the intent of the model to prescribe how a site achieves each accomplishment; rather, the goal is to provide sites with the latitude and flexibility to operationalize processes and practices towards each accomplishment, encouraging exploration of local considerations and creative paths.

To assist sites in determining “Are we there yet?” a WHS Self-Assessment tool is available. It is recommended you read this document in its entirety before completing the WHS Self-Assessment Tool. This tool is intended to be used in conjunction with other OPCC&CT resources and with FIT consultation.

PREPARATION FOUNDATIONAL DEVELOPMENTALFULL

GOVERNANCE

OPERATIONS

PATHWAY

WELL-BEING

PROGRAM

WHOLE HEALTH

CLINICAL CARE

EMPLOYEE

WHOLE HEALTH

COMMUNITY

PARTNERSHIPS

Phase 1 Phase 2 Phase 3 Phase 4

D om ai ns

Maturity

WHAT DOES THE FUTURE STATE LOOK LIKE?

WHAT WILL BE DIFFERENT FOR THE VETERAN?

• Key milestone accomplishments are described for each phase within each domain.

• It is anticipated that sites will work through WH implementation at different paces.

• How these accomplishments are achieved may vary from site to site.

DESIGNATION FRAMEWORK FOR WHOLE HEALTH IMPLEMENTATION: BACKGROUND AND CONTEXT

BACKGROUND: Like the “Department of Veterans Affairs 2018-2024 Strategic Plan” and VHA Modernization efforts, the Designation Framework for Whole

Health Implementation was designed with a Veteran-driven system of care mindset. Implementing Whole Health represents a comprehensive and systematic approach to provide whole health care at any stage of the relationship between VA and the Veteran. Moving from episodic to a holistic approach, it emphasizes self-care in the larger context of well-being, incorporating a full range of conventional and Complementary and Integrative Health (CIH) approaches to optimize lifelong Veteran health and well-being. The VA Whole Health System is based on three central components: Pathway; Well-Being Program; and Whole Health

Clinical Care. The Personal Health Plan—a living document which grounds the approach to care in what matters most to the Veteran—forms the basis of decision-making and treatment planning as the Veteran moves through and across the continuum of care. Clinical practice is changing from a primary focus on

‘What’s the matter with you?’ to one that asks, ‘What matters to you and how can we help you live your best life?’ Rather than solely chasing disease, the goal is to optimize health and well-being as viewed through the Veteran’s lens.

The Designation Framework was designed to describe the future state when the Whole Health System is implemented and what will change from the site perspective and, even more importantly, from the Veteran perspective. It is a forward-looking framework that describes desired outcomes along the Whole

Health implementation journey. To achieve these outcomes, key milestones were identified through the cumulative efforts and review by a multi-disciplinary workgroup (represented by OPCC&CT, EPCC/CHOIR, VISN and the field) as well as several content reviews by Whole Health subject matter experts and 10 volunteer VHA sites/facilities. In doing so, a common set of objectives and accomplishments were established. It is anticipated the Designation Framework will continue to evolve as we all learn from each other and teach each other in collaboration.

PURPOSE: To make transformational change, like large-scale implementation of the Whole Health System, the future state should be clear in terms of what will change from the site perspective and, even more importantly, from the Veteran perspective. The Designation Framework addresses the question “Where are we going?” The journey towards Whole Health transformation is more than changing actions or completing activities. It is about changing habits and behaviors to ultimately impact our system values and beliefs. The Designation Framework describes this transformational journey, which ultimately (in theory) would result in full transformation and designation as a Whole Health system via a certification process.

HOW TO USE THIS MODEL: The Designation Framework was NOT designed to provide the details and granularity for Whole Health implementation. Rather, the Designation Framework focuses on desired outcomes in terms of what will be different at the site and most importantly for the Veteran. Specifically, the

Designation Framework outlines milestones and accomplishments sites can achieve as they progress through four phases of Whole Health transformation and cultural maturity: Preparation, Foundational, Developmental, and Full. It describes key accomplishments across each phase and organized around seven domains of focus: Governance, Operations, Pathway, Well-Being Program, Whole Health Clinical Care, Employee Whole Health, and Community Partnerships.

How these accomplishments are achieved may vary from site to site. It is anticipated and understood that sites will work through Whole Health implementation at different paces, and how each site will integrate Whole Health with other existing programs, services, partners, and stakeholders (e.g., Mental Health, Healthy

Living Teams, PACT, Social Work, Public Affairs, Nursing, VSOs, etc.) will differ based on local site considerations.

Remember, it is NOT the intent of the Designation Framework to prescribe how a site achieves each accomplishment. Instead, the goal is to provide sites with latitude and flexibility in how they choose to operationalize processes and practices towards each accomplishment, encouraging exploration of local considerations and creative paths. As sites progress through each phase, each site will promote partnerships within existing VA/VHA programs and explore expansion capabilities and offerings via multiples options in service of milestone achievement.

Guidance and recommendations on the “how” can be obtained via multiple resources offered by the Office of Patient Centered Care and Cultural

Transformation (OPCC&CT), to include OPCC&CT FIT consultation and Whole Health System Implementation Guide. Ultimately, achievement of these milestones along all four phases provides a site the opportunity to apply for distinguished recognition as a premier Whole Health facility. A site must complete all accomplishments along the four phases before pursuing certification and designation as a fully transformed Whole Health System facility.

WHOLE HEALTH SYSTEM (WHS) SELF-ASSESSMENT TOOL: To assist sites in determining “Are we there yet?” a WHS Self-Assessment tool to accompany the

Designation Framework is available. Accomplishments from each phase of the Designation Framework have been transferred into this tool as discrete elements that can be scored individually. Intended for individual site use, the WHS Self-Assessment tool can aid a site in identifying and organizing Whole Health initiatives and priorities, and potentially apply it to the development of a VISN and/or site strategic plan and/or project plans, thus bridging the gap between the current state and future state vision.

ADDITIONAL CONTEXT: In June 2018, a Whole Health Designation Model Workgroup comprised of OPCC&CT, QUERI, Field and VISN representatives was stood up to design the framework. The Workgroup took the following approach regarding maturity along the phases and organization of the accomplishments. The term “Whole Health Designation Model” was ultimately changed to “Designation Framework for Whole Health Implementation”.

The focus of each phase is:

• Phase 1 Preparation: Preliminary stages of implementation, such as planning (which should include intentional milestones ranging from initial implementation of core Whole Health offerings to expansion of efforts beyond initial start-up), conducting assessments, completing gap analyses, and determining how best to reach Veterans along the Designation Framework phases. This process will include decisions about whether to start mostly on campus/in-house versus beyond the campus/within the community and when to explore expansion. Design efforts should be conducted from the lens of the Veteran with intent to evaluate and validate accessibility and effectiveness in engaging, empowering, and equipping Veterans.

• Phase 2 Foundational: Implementation of the core structure and processes with the primary support hub at the main campus. The intent is to introduce both Veterans and employees to Whole Health and begin embedding personal health planning as the integral foundation for exploring what matters most.

• Phase 3 Developmental: Sustainment of the core structure with proactive efforts to expand and enhance the existing foundation through active and continuous evaluation and validation of efforts to reach and partner with Veterans, connect them to Whole Health approaches, and to explore and initiate expansion of capabilities (i.e. telehealth, CBOCs, community). The intent is to enhance integration of the Whole Health System components.

• Phase 4 Full: Focus on cultural evolution of the site as a Whole Health System which results in Veteran-driven care and lifelong optimization of health and well-being for Veterans. Because the site is focused on the integration of care with the Personal Health Plan (PHP) as the basis for critical connections and coordination, the site is a welcomed and trusted partner. The site offers a variety of points of entry into the system, expands offerings on an ongoing basis to meet Veteran demand, and is working towards full integration with all domains of the Designation Framework.

The Workgroup catalogued certain topics within the Governance and Operations domains rather than repeating them in multiple domains. For example, the following topics were assigned to the Governance domain:

• Strategic planning

• Metrics tracking

• Performance measurement and outcome evaluations

• Leadership engagement, leadership development and leadership experiential training.

Whereas the following topics were assigned to the Operations domain:

• Veteran engagement and input

• Communications (internal and external) to include Veteran outreach and Whole Health marketing and branding

• Hiring staffing, performance appraisals, credentialing

• Staff training with the experiential element being a critical distinguishing factor

• Documentation and coding infrastructure

• Facility and space planning

Some topics were purposefully repeated to emphasize its importance. Language about Veteran’s Mission, Aspiration, and Purpose (MAP), Personal Health

Inventory (PHI) tool, Personal Health Planning (PHP) documentation, and personal health planning are emphasized in multiple domains given the foundation these play in a Veteran-driven system of care. The interface and integration of the Whole Health System (WHS) component domains are repeated throughout to promote accessibility to each of the WHS components in supporting Veterans, families, and caregivers.

Referral processes are also found in multiple domains: in the Operations domain to emphasize the infrastructure piece, as well as the WHS component domains to emphasize the behaviors and actions related to use of referrals in the integration of the Whole Health approach.

Special thanks to the Workgroup members:

Anika Doucette (OPCCCT FIT), Eileen Dryden (EPCC/QUERI), Donna Faraone (OPCC&CT FIT), Linda Harrison (OPCC&CT), Justeen Hyde (EPCC/QUERI), Maureen

Khung (OPCCCT FIT Leadership), Pamela LeDeaux (VISN Network Sponsor), James Marzolf (OPCC&CT), Christine Palarca (OPCC&CT), Lauri Phillips (OPCC&CT

Leadership), Mary Quilty (MITRE), Craig Triscari (OPCC&CT FIT), Kelly Unrein (WH Administrative Director), Stacy Valenti (OPCC&CT).

GOVERNANCE

Domain Transformative Objective As a fully transformed organization:

Leadership commitment to Whole Health concepts are evidenced by their seamless incorporation into the organization’s broader strategic plan and operational decision-making. In addition, leadership demonstrates commitment to Whole Health in attitude, behaviors and day-to-day conversation and interactions with staff at all levels in the organization.

Veteran participation and engagement in organizational decision making is embraced by leaders and staff at all levels, and such partnerships are considered critical to organizational strength and are based on mutual trust and respect.

Domain Components:

• Veteran engagement and input with feedback mechanisms

• Governance structure and processes are integrated, reflect adoption of Whole Health behaviors and mindset

• Whole Health is incorporated and woven into strategic planning

• Leadership engagement and commitment

• Leadership training in Whole Health, which includes the experiential element

• Performance improvement activities

• Outcomes aligned with organizational incentives

• Accountability

PHASE OVERVIEW ACCOMPLISHMENTS

PHASE 1:

PREPARATION

Site is actively designing and in the beginning states of building a Whole Health governance structure. The effort may be driven primarily by a limited number of Whole Health champions from throughout the organization and with the support of a senior (Executive Leadership Team) leader.

• Identify governance members.

• At least one member of the organization’s Executive Leadership Team is a Whole Health champion.

• Define the structure for oversight of Whole Health activities.

• Draft a written Whole Health charter or other document that outlines the responsibilities of the site’s Whole Health governing entity(ies).

• Explore options for recruiting an active Veteran representative as part of the site’s governing entity to ensure Veteran engagement and input.

• Identify Whole Health champions for major service/product lines to facilitate Whole Health adoption.

• Complete a needs assessment and environmental scan to define the site’s Whole Health approach.

• Draft a Whole Health strategic plan.

• Develop a plan to regularly track and monitor Whole Health utilization, cost data, and outcomes.

PHASE 2:

FOUNDATIONAL

A basic Whole Health governance structure is in place and has begun operations. All senior leaders are knowledgeable about and support Whole Health.

• Secure VISN and local executive leadership sponsors.

• Designate the primary Whole Health POC.

• Finalize a written Whole Health charter or other document that outlines the responsibilities of the site’s Whole Health governing entity(ies).

• All senior leadership complete Whole Health training, which allows for participants to have a Whole Health personal experience.

• Establish process to orient new leadership to core Whole Health concepts, which also allows for individual WH experiential element.

• Establish Whole Health liaisons for relevant/appropriate service/product lines.

• Whole Health strategic plan is finalized and implemented.

• The main/core Whole Health steering committee/governing entity is operational.

• Veteran member of steering committee/governing entity is recruited and in place.

• Establish a process to capture broader Veteran input into site governance.

• Establish processes to regularly track and monitor Whole Health utilization, cost data, and outcomes.

PHASE 3:

DEVELOPMENTAL

The basic Whole Health governance structure is in place and meets regularly to support how Whole Health implementation supports efforts to empower and equip Veterans, families and caregivers via governance structures/mechanisms which expands Veteran input into corporate decision making and incorporates Whole Health into strategic planning.

• Whole Health strategic plan is in use and is updated to reflect Whole Health expansion and initial outcomes.

• Whole Health governance entity meets regularly to assess implementation.

progress and to support decision making and quality improvement efforts.

• Whole Health governance entity represents a broad range of service/product lines, both clinical and administrative and inclusive of Whole Health peer facilitators, Whole Health Partners, and non-clinical.

• In addition to senior leaders, Service Chiefs and program managers complete.

Whole Health training and have completed at least one personal WH experience.

• Dissemination of Whole Health representation into other Medical Center or Health Care System committees has begun.

• The site has begun to incorporate Whole Health principles/approaches into the organization’s policies and procedures where appropriate.

• Veteran input into facility governance has expanded.

• Veteran perspectives help inform Whole Health System transformation via a Patient Family Advisory Committee (PFAC) or equivalent group.

• Evidence of monitoring and tracking of appropriate outcome measures that assess the positive benefits of the WHS approach on Veteran lives, the efficiency and effectiveness of health care delivery, and the organization’s financial health.

PHASE 4:

FULL

A robust and influential Whole Health governance structure, including significant and meaningful Veteran input, is in place. Leaders at all levels throughout the organization are knowledgeable and in support of

• Whole Health governance is maintained as an entity with organizational influence. Accountability for Whole Health implementation is clearly integrated.

• All leaders (supervisors, managers, Chiefs, executive leadership, etc.) complete Whole Health training, which includes a personal Whole Health experience.

• Whole Health strategic plan is in use and routinely validated and updated.

Whole Health. Whole Health is routinely incorporated into strategic planning.

• All new leaders (supervisors, managers, Chiefs, executive leadership, etc.) receive Whole Health onboarding, including an experiential component, and reliable.

processes are in place to periodically reeducate leaders in Whole Health principles.

• Whole Health is infused into all existing hospital committees as appropriate.

• Whole Health principles/approaches are routinely incorporated into the organization’s policies and procedures where appropriate.

• Evidence exists of widespread and meaningful Veteran participation, input, and influence into organizational decision making and strategic planning.

• Evidence of ongoing tracking of appropriate outcome measures that assess the positive benefits of the Whole Health approach to care on Veteran lives, the efficiency and effectiveness of health care delivery, and the organization’s financial health. The data generated through this process is regularly incorporated into performance improvement activities.

• Evidence that Veterans readily provide feedback on value and satisfaction in attending Whole Health activities.

• Evidence that the site regularly uses participation, satisfaction rates, and other inputs as appropriate to tailor Whole Health offerings and approaches based on

Veteran feedback and demand.

• Evidence of leadership commitment/engagement.

DESIGNATION As a fully transformed organization:

Leadership commitment to Whole Health concepts are evidenced by their seamless incorporation into the organization’s broader strategic plan and operational decision-making. In addition, leadership demonstrates commitment to Whole Health in attitude, behaviors and day-to-day conversation and interactions with staff at all levels in the organization.

Veteran participation and engagement in organizational decision making is embraced by leaders and staff at all levels, and such partnerships are considered critical to organizational strength and are based on mutual trust and respect.

• Clear evidence exists of the influence of Whole Health on strategic and operational decision making. Whole Health concepts are incorporated into the organization’s strategic plan rather than being a separate entity.

• Corporate decision making routinely prioritizes support for Whole Health activities, offerings and approaches that further the goals of increasing Veteran engagement, enhancing health and well-being, which allow them to live fulfilled lives.

• Leaders at all levels are skilled at communicating about Whole Health and capitalize on opportunities to educate and guide subordinates to establish and/or maintain initiatives that help Veterans achieve Whole Health ideals.

• Whole Health concepts are infused throughout the organization’s written policies, procedures, committee minutes, and operational documents and are evident in day-to-day processes.

• Leaders at all levels within the organization receive thorough orientation/onboarding to Whole Health concepts which include the experiential element. Periodic refresher courses and other opportunities for learning and Whole Health experiences are offered to and attended by these leaders.

• Leaders at all levels lead by example, demonstrating strong commitment to Whole Health principles. Evidence exists of regular leadership participation and presence at Whole Health training sessions offered to front line staff.

• Evidence exists of ongoing, systematic efforts to seek and expand opportunities to solicit meaningful feedback from Veterans and other stakeholders into governance and corporate decision making.

• Clear evidence exists of the positive benefits of the Whole Health approach on Veteran lives, the efficiency and effectiveness of health care delivery, and the organization’s financial health. The evaluation and tracking plan is regularly validated and updated as needed.

• Evidence that Veterans have made positive changes towards well-being. This may include participation in well-being activities offered by the site, and/or those pursued externally.

• Transitioning service members choose VA care.

OPERATIONS

As a fully transformed organization:

Whole Health concepts are seamlessly incorporated into the organization’s staffing, training, communications, operations, and environment.

The influence of Whole Health has impacted the operations of the organization in such a way that it is clearly evidenced by the experience felt and feedback given by Veterans, their family members, volunteers, and staff.

Domain Components:

• Veteran outreach

• Staff planning o Hiring and recruitment of committed, qualified Whole Health staff who will encourage and advance Whole Health System transformation o Credentialing

• Staff and volunteer training in Whole Health, which includes the experiential element

• Space planning

• Communications

• Documentation

PREPARATION

Site is actively designing and in the beginning stages of building the infrastructure to support Whole Health implementation in the areas of staff planning, hiring, training, credentialing, space planning,

• Complete a needs assessment and develop a Whole Health staffing plan for key Whole Health roles (Whole Health Program Manager, Whole Health Clinical Director, Whole Health Education Champions (MD and non-MD) and administrative support).

• Identify staff interested in Whole Health and their related skills communications, and documentation and coding processes.

• Identify staff to fulfill the four (4) key Whole Health roles (Whole Health Program Manager, Whole Health Clinical Director, Whole Health Education Champions (MD and non-MD) and administrative support). These staff are beginning to fulfill these roles with protected time or as a collateral assignment.

• Develop an initial plan for Whole Health peer facilitators and Whole Health Partners (number to hire, scope of practice, development of core competencies, indoctrination/mentorship of, etc.).

• Develop an initial plan for Whole Health coaching, (number to hire, scope of practice, development of core competencies, indoctrination/mentorship of, etc.).

• Determine CIH provider roles to hire for List 1 and any other CIH approaches to be offered.

• Plan mechanisms to incorporate Whole Health concepts into the hiring process.

• Develop Whole Health staff training plan and schedule, including experiential elements and application of Whole Health to their lives.

• Establish process for credentialing CIH providers.

• Develop position descriptions and performance plans on key roles (education champions, clinical director, program manager, and admin support).

• Initiate staff training for key roles.

• Complete review of Whole Health materials available from OPCC&CT to support implementation.

• Conduct a needs assessment and develop an initial communication and outreach plan.

• Conduct needs assessment and both an internal and external (community) environmental scan to develop initial Whole Health space plan.

• Initiate actions/requests to secure space on or offsite for initial WHS components and staff.

• Complete environmental scan to assess coding, documentation needs (including development and sharing of Veterans’ MAP, PHI, PHP) and referral processes.

PHASE 2:

FOUNDATIONAL

The basic Whole Health infrastructure is in place in support of core elements of Whole Health.

• Initiate actions to transition the key Whole Health roles to permanent, non-collateral positions (note: it is recognized that education champions will likely remain collateral positions)

• Develop a staffing plan for Whole Health beyond key staff

• Process is in place and operational to recruit process to recruit Whole Health peer facilitators and Whole Health Partners from within or external to VA.

• Hire/identify Whole Health peer facilitators, Whole Health Partners and Whole Health Coaches.

• Site has the necessary CIH providers to support initial List 1 CIH offerings, either internal to the organization or through community partnerships

• Establish mechanisms to incorporate Whole Health concepts into the hiring and performance appraisal processes.

• Whole Health staff have attended training appropriate for their role and opportunities to apply Whole Health into their lives.

• Implement the initial communication and outreach plan.

• Secure space for initial Whole Health care offerings and approaches.

• Key Whole Health staff assigned space.

• Stakeholder feedback, to include Veterans, family, and caregivers have been incorporated into space planning and design.

• Establish OPCC&CT-recommended coding infrastructure in appropriate service/product lines and for the system as a whole to capture initial Whole Health offerings and approaches.

• Establish Whole Health documentation processes for Veterans’ MAP, PHI, PHP.

PHASE 3:

DEVELOPMENTAL

The Whole Health infrastructure is actively expanding staffing, systems and offerings to meet Veteran demand.

• Four (4) key Whole Health roles are in place with a designated staff member permanently supporting the work to a significant extent.

• Whole Health staffing and partnerships are expanding to meet demand.

• Whole Health offerings are expanding to meet demand.

• Staff training is expanding beyond Whole Health staff as appropriate for their role, including opportunities to apply Whole Health into their lives.

• Enhanced the initial communication and outreach plan to reflect a comprehensive internal and external communication, marketing and outreach strategy to raise awareness of Whole Health at the site and in the community, and to reach target populations, including alignment with strategic priorities and key programs.

• Veterans and employees have Whole Health information and resources available onsite and offsite through appropriate mechanisms (ex: online, etc.).

• Space is expanding onsite and/or offsite as appropriate as the offerings expand and grow.

• Revise and/or expand coding infrastructure appropriately to capture expanded Whole Health offerings

• Documentation of Veterans’ MAP, PHI, PHP in the electronic medical record is expanding.

PHASE 4:

FULL

A complete and effective Whole Health infrastructure is in operation within the organization and/or through community partnerships. Reliable processes, resources, space and staff are in place to consistently deliver a Whole Health approach to Veterans engaged in all services in a healing environment and through healing relationships.

• Four (4) key Whole Health roles are in place with a designated staff member permanently supporting the work so that the organization's needs are fully met.

• Whole Health staffing is sufficient to meet demand.

• Whole Health offerings are sufficient to meet demand, either internally or through community partnerships.

• All staff receive training in Whole Health as appropriate for their role, including opportunities to apply Whole Health into their lives.

• Implement, maintain and regularly update a comprehensive internal and external communication, marketing and outreach strategy to raise awareness of Whole Health at the site and in the community, and to reach target populations, including alignment with strategic priorities and key programs.

• Sufficient space is available to conduct Whole Health work onsite or through offsite agreements as appropriate.

• All Whole Health offerings are appropriately set up/reviewed/tracked for proper clinic set-up, CPT/HCPCS coding, CHAR 4 codes, and note titles.

• Evidence of routine documentation of Veterans’ MAP, PHI, PHP in the electronic medical record.

• Mechanisms are established so that Veterans have open, ongoing access to their MAP, PHI, PHP to make updates, changes, and comments.

• Fully implement reliable coding processes to allow site to track, review, and assess Whole Health offerings provided via community care.

Whole Health concepts are seamlessly incorporated into the organization’s staffing, training, communications, operations, and environment.

The influence of Whole Health has impacted the operations of the organization in such a way that it is clearly evidenced by the experience felt and feedback given by Veterans, their family members, volunteers, and staff.

• Executive leadership at the site serve as thought leaders within and outside the VA, championing for change in the greater U.S. health care system.

• Hiring and recruiting practices have been effectively modified to attract passionate and qualified staff that practice a Whole Health approach to health care.

• Staff at all levels within the organization receive thorough orientation/onboarding to general Whole Health concepts and to their more specific, job-related roles, including experiential components. Periodic refresher courses and other opportunities for learning and experiences are offered and attended.

• An effective communication and outreach plan creates and maintains an ongoing, high level of awareness in the community about Whole Health and the programs available at the site.

• Staff commitment to Whole Health concepts are evident in words, behaviors and day-to-day interactions at all levels in the organization.

• Resource allocation routinely prioritizes support for activities and offerings that further the goals of increasing Veteran engagement, enhancing well-being, health, and allowing them to live fulfilled lives.

• Coding infrastructure and processes accurately capture Whole Health activity and workload to support the financial health of the organization.

• Veterans have open, ongoing access to their MAP, PHI, PHP to make updates, changes, and comments. Such updates are available to the health care team in a timely manner.

• The electronic health record facilitates collaboration and coordination of WH care via MAP, PHI, PHP including system prompts to align care across programs/WHS components.

• Staff at all levels are skilled at communicating about Whole Health, applying it to their own lives, and promoting this approach to Veterans.

• All facility space has been redefined, for both staff and Veterans, using evidence based design to serve as a healing environment and support healing relationships.

• Veterans encourage each other, especially new Veterans, to participate in Whole Health, thus helping to drive the Whole Health movement.

PATHWAY

As a fully transformed organization:

An empowering and vital Whole Health Pathway has been established, introducing Veterans, family members, and caregivers to Whole Health and creating opportunities for Veterans to explore their personal mission, aspiration, purpose (MAP) and what matters most. In doing so, Veterans begin personal health planning and connect seamlessly to support, skill-building, and needed health care. With the Personal Health Plan as the basis for integration of health care for Veterans, the components of the Whole Health System—the Pathway, Well-Being Program, and Whole Health Clinical Care—are tightly and explicitly interwoven. Because Veterans can connect and partner with passionate staff and fellow peers who believe in the Whole Health approach and access VA resources to optimize their health and well-being, Veterans are engaged in self-care and feel empowered to take charge of their health and well-being and live their life to the fullest.

Domain Components:

• Taking Charge of My Life and Health

• Introduction to Whole Health

• Support from Whole Health peer facilitators and Whole Health Partners

• Contributions by volunteers/Voluntary Service

• Veteran recruitment

• Pathway planning, execution and delivery

• Integration of Pathway with Whole Health Clinical Care and Well-Being Program

• Referral processes and points of entry

PREPARATION

With the Veteran’s personal health planning process as the foundation for exploring what matters most, the site is actively designing and building a Whole Health Pathway which empowers Veterans via multiple, supportive connections and partnerships.

• WHOLE HEALTH CORE: Develop plan for offering the Whole Health peer facilitator and/or Whole Health Partner led Taking Charge of My Life and Health, which includes intentions for expansion beyond initial offering which should be accessible to majority of Veterans. Should include Veteran education and the opportunity to complete a holistic self-assessment (e.g. Personal Health Inventory) that results in identifying their Mission, Aspiration, Purpose and being completion of the Personal Health Plan with Veteran developed goals for enhancing health and well-being. (Individual/Group).

• Develop plan for offering Introduction to Whole Health (Intro to Whole Health) sessions to invite Veterans to engage in Whole Health Pathway.

• ONGOING SUPPORT: Develop plan for providing on-going Whole Health peer facilitator and Whole Health Partner support (i.e. goal setting; motivation) for Veterans with a Personal Health Plan.

• Develop a recruitment strategy for enrolling Veterans into Pathway (Intro to Whole Health & Taking Charge of My Life and My Health).

• Design linkages among Pathway and the other Whole Health System components so Veterans have access to Whole Health Well-Being Program and to Whole Health Clinical Care as needed to support Veterans’ health and well-being.

PHASE 2:

FOUNDATIONAL

The fundamental core of the Whole Health Pathway is in place with a primary support hub at the main campus, which collectively enable and encourage Veterans’ introduction to Whole Health, connection, and accessibility to Pathway offerings.

• WHOLE HEALTH CORE: Offer the Whole Health peer facilitator and/or Whole Health Partner led Taking Charge of My Life and Health via a means accessible to majority of Veterans. Includes Veteran education and the opportunity to complete a holistic self-assessment (e.g. Personal Health Inventory) that results in identifying their Mission, Aspiration, Purpose and being completion of the Personal Health Plan with Veteran developed goals for enhancing health and well-being. (Individual/Group).

• Offer Introduction to Whole Health to invite Veterans to engage in Whole Health Pathway.

• ONGOING SUPPORT: Implement plan for providing on-going Whole Health peer facilitator and Whole Health Partner (i.e. goal setting; motivation) for Veterans with a Personal Health Plan.

• Implement recruitment strategy for enrolling Veterans into Pathway (Intro to Whole Health &Taking Charge of My Life and My Health).

• Implement linkages among Pathway and the other Whole Health System components so Veterans have access to Well-Being Program and to Whole Health Clinical Care as needed to support Veterans’ health and well-being.

PHASE 3:

DEVELOPMENTAL

With the core Whole Health Pathway in sustainment, the site is intentional and continually evaluating and strengthening its reach to Veterans by refining outreach efforts and validating Pathway effectiveness. As the site explores expansion of offerings (i.e. telehealth, CBOCs, community), integration of the Pathway with the other Whole Health System components is essential.

• WHOLE HEALTH CORE: Expand the Whole Health peer facilitator and/or Whole Health Partner led Taking Charge of My Life and Health group offerings via multiple means, which could include beyond the main campus and/or across other platforms or formats as appropriate to improve accessibility. Includes Veteran education and the opportunity to complete a holistic self-assessment (e.g. Personal Health Inventory) that results in identifying Mission, Aspiration, Purpose and a Personal Health Plan with Veteran developed goals for enhancing health/well-being. (Individual/Group).

• Expand offerings of Introduction to Whole Health beyond the main campus and/or across other platforms (ex: online, telehealth, etc.) to invite Veterans to engage in Whole Health Pathway.

• Establish processes to track and monitor effectiveness of recruitment strategy for enrolling Veterans into Pathway approaches (Intro to Whole Health & Taking Charge of My Life and My Health).

• ONGOING SUPPORT: Establish processes to track and monitor the provision of on-going Whole Health peer facilitator and Whole Health Partner support (i.e.

goal setting; motivation) for Veterans with a Personal Health Plan.

• Assess impact and effectiveness of recruitment strategy for enrolling Veterans into Pathway offerings (Intro to Whole Health & Taking Charge of My Life and My Health).

• Evaluate effectiveness of linkages Pathway and the other Whole Health System components so Veterans have access to Well-Being Program and to Whole Health Clinical Care as needed to support Veterans’ health and well-being.

• Establish policies and processes which promote a seamless connection with Well- Being Program and Whole Health Clinical Care.

PHASE 4:

FULL

A vibrant and vital Whole Health Pathway which empowers Veterans via multiple, supportive connections and partnerships is in dynamic operation, well utilized, and endorsed by Veterans. Because the site is focused on the integration of care with the PHP as the basis for coordination of care, the site offers a variety of points of entry into the system, expands offerings on an ongoing basis to meet Veteran demand, and is working towards full integration with all DM domains.

• WHOLE HEALTH CORE: An effective, well-advertised and marketed Whole Health peer facilitator and/or Whole Health Partner led group Taking Charge of My Life and Health is offered. Sessions are scheduled and delivered through a variety of methods, locations and formats appropriate to the site’s Veteran population and accessible to Veterans at all locations served. Includes Veteran education and the opportunity to complete a holistic self-assessment (e.g. Personal Health Inventory) that results in identifying Mission, Aspiration, Purpose and a Personal Health Plan with Veteran developed goals for enhancing health/well-being.

(Individual/Group).

• Evidence that a consistent and widely accessible Introduction to Whole Health, facilitated by trained Whole Health peer facilitators and Whole Health Partners, is offered to invite Veterans to engage in Whole Health Pathway. The sessions are offered at or across a variety of locations/platforms (ex: online, telehealth, community etc.), are well attended, and are effective in reaching target audiences.

• Veterans routinely participate in his/her personal health planning process by timely Mission, Aspiration, and Purpose exploration via regular review of PHI results and PHP development.

• Evidence of an effective, widespread recruitment strategy for enrolling Veterans into Pathway offerings (Intro to Whole Health & Taking Charge of My Life and Health) that is regularly updated and validated.

• ONGOING SUPPORT: Evidence of an effective system for providing on-going Whole Health peer facilitator and Whole Health Partner support (i.e. goal setting;

motivation) for Veterans with a Personal Health Plan. The system is regularly validated and updated as appropriate. The system is easily accessible to Veterans at all locations served and meets Veteran demand.

• Evidence of seamless connection with Well-Being Program and Whole Health Clinical Care components.

An empowering and vital Whole Health Pathway has been established, introducing Veterans, family members, and caregivers to Whole Health and creating opportunities for Veterans to explore personal mission, aspiration, purpose (MAP) and what matters most. In

• A shared understanding by Veterans, providers, and staff exists that Whole

Health and the personal health planning process specifically will help them lead fulfilling lives. With the Veteran’s MAP and results of the PHI accessible through the PHP within the medical record, the Veteran can be engaged in his/her self-care and self-healing and connect with relevant Whole Health approaches and needed health care.

doing so, Veterans begin personal health planning and connect seamlessly to support, skill-building, and needed health care. With the Personal Health Plan as the basis for integration of health care for Veterans, the components of the Whole Health System, the Pathway, Well-Being Program, and Whole Health Clinical Care, are tightly and explicitly interwoven. Because Veterans can connect and partner with passionate staff and fellow peers who believe in the Whole Health approach and access VA resources to optimize their health and well-being, Veterans are engaged in self-care and feel empowered to take charge of their health and well-being and live their life to the fullest.

• Pathway offerings are fully aligned with and have been adjusted for the needs of the site’s Veteran population and locale. Considerations include Veteran demand, demographics, needs and preferences within the servicing area.

• Pathway offerings are well utilized and easily accessible to Veterans through a variety of avenues, such as telehealth, online classes/resources, unique scheduling options, etc. The site proactively creates new delivery options that are tailored to the evolving needs of their Veteran population.

• Pathway approaches are available at or through all internal locations, and a wide, robust network of community and/or interagency partnerships has been established as appropriate for recruitment and availability of Whole Health offerings.

• Referral processes are in place at all points of entry into the system, seamlessly connecting Veterans to Whole Health approaches and needed health care in a timely manner

• The site expands WH approaches on an ongoing basis to meet Veteran demand, and proactively plans for this possibility.

• The site is recognized for innovative approaches to the availability, delivery and effectiveness of Pathway offerings.

WELL-BEING PROGRAM

As a fully transformed Whole Health organization: The organization is agile in its ability to equip Veterans with the skills and support needed for self-care and well-being. The evolving needs of the site’s local Veteran population, Veteran demand, and demographics are considered to inform Well-Being Program requirements. A wide range of innovative well-being approaches are easily accessible to Veterans including well-being/skill building classes, complementary and integrative health (CIH) approaches and health coaching. Veterans can select activities based on his/her personal health plan, which includes timely exploration of Veterans’ Mission, Aspiration, and Purpose (MAP) via regular review of PHI results and PHP development. There is a seamless connection among Well-Being Program, Pathway, and Clinical Care components of the Whole Health System (WHS) with the Personal Health Plan as the basis for integration of care and services for Veterans.

Domain Components:

• Well-Being Program planning, execution and delivery

• Well-being/skill-building classes

• CIH approaches

• Whole Health coaching

• Integration of Well-Being Program with the other WHS components

• Processes to track points of entry and coordinate care

• Mechanisms to access offsite well-being care as needed to meet Veteran demand and to promote integration with community well-being resources

PREPARATION

The site is actively designing and building an agile Well- Being Program which equips Veterans with the skills and support for self-care and well-being.

• Complete gap analysis comparing existing well-being classes and CIH approaches offered at the site against mandatory requirements of a Well-Being Program., i.e.

well-being classes, CIH approaches (mandatory List 1 and optional List 2), and

Whole Health coaching. Note, not all List 1 CIH approaches must be in the Well-

Being Program as they can be in Whole Health Clinical Care.

• Explore and identify multiple processes for Veterans to access the Well-Being

Program, considering self-referral options as well as other mechanisms to access the Well-Being Program from the Pathway and Whole Health Clinical Care.

• Determine which well-being offerings will fall under the Well-Being Program, identifying those that will be initially added and where (i.e. on campus versus off campus).

• Identify strategies to assess for adequacy and ease of access to those well-being approaches provided off-site in the community and/or virtually (such as telehealth or online) as part of the Veteran’s personal health plan.

• Develop plan to institute a Well-Being Program orientation, which could be separate or combined with the site’s Introduction to Whole Health.

• Develop mechanism for Veterans to readily access Whole Health coaching when needs extend beyond the support of the Whole Health peer facilitator and Whole

Health Partner.

• Identify ways to integrate MAP and PHP in Well-Being Program offerings, in coordination with other WHS components.

• Design linkages among Well-Being Program and the other Whole Health System components so Veterans have access to Whole Health peer facilitators and Whole

Health Partners and to Whole Health Clinical Care as needed to support health and well-being.

• Develop processes to track points of entry (e.g. via Pathway, Whole Health Clinical Care or Veteran self-enrollment) into Well-Being Program offerings to evaluate program utilization and interface with other WHS components.

• Explore ways to encourage Veteran feedback on Well-Being Program offerings, ensuring the site is meeting Veteran needs based on MAP and PHP.

PHASE 2:

FOUNDATIONAL

The fundamental core of the Well-Being Program is in place with a primary support hub at the main campus.

The Well-Being Program enables and encourages Veterans’ self-care through support and accessibility to

• Implement multiple processes for Veterans to access the Well-Being Program, ensuring self-referral is possible.

• Implement strategies to assess adequacy and ease of access to well-being approaches provided off-site in the community and/or virtually (such as telehealth or online) as part of the Veteran’s personal health plan.

well-being/skill building classes, CIH approaches, and WH coaching.

• Institute and incorporate Well-Being Program orientation to expand Veterans’ understanding of offerings and encourage enrollment (based on MAP and PHP).

Well-Being Program orientation could be incorporated into the Pathway’s Intro to

Whole Health or separate.

• Begin to establish well-being/skill building class tracks.

• Provide at least 4 of the List 1 CIH approaches on site and/or via community referral, while continuing to actively pursue mechanisms to offer remaining List 1 CIH approaches.

• Institute mechanism for Veterans to readily access Whole Health coaching when needs extend beyond the support of Whole Health peer facilitator and Whole Health Partner.

• Establish accessibility of Veteran’s PHP to well-being providers/instructors, CIH providers, and Whole Health Coaches to foster ease of partnering and engaging with the Veteran.

• Implement linkages among Whole Health System components so Veterans have access to Whole Health peer facilitator and Partners and to Whole Health Clinical Care as needed to support Veterans’ health and well-being.

• Implement processes to track points of entry (e.g. via Pathway, Whole Health Clinical Care or Veteran self-enrollment) into Well-Being Program offerings to evaluate Program utilization and…