Whole Health: Results and lessons learned from the VA's Cultural Transformation

Presentation Summary: Whole Health (WH) is a patient-centered model of care being implemented by the Veterans Health Administration. The roll-out of Whole Health across the VA is the most extensive application of lifestyle medicine in any healthcare system. Last year, over two million veterans were touched by Whole Health. Recent findings demonstrate that those participating in Whole Health programs and services have improved health metrics, improved perception of care and increased engagement in their care. The ongoing roll-out of the Whole Health model of care provides vast experience in overcoming challenges and enjoying successes that can be readily shared and applied in practices and healthcare systems beyond the VA. The impact of Whole Health also extends to employee health. Employees who reported involvement with Whole Health or who participate in Whole Health for themselves reported their facility as a "best place to work," lower voluntary turnover; lower burnout; and greater motivation.

As was noted in a recent publication, “The concept of whole person health is one that is being adopted by many agencies, including the National Institutes of Health (NIH). A recent report from the National Academies of Sciences, Engineering, and Medicine (NASEM) defines Whole Health as “physical, behavioral, spiritual, and socioeconomic well-being as defined by individuals, families, and communities.” At times, WH care has been considered to be the provision of non-traditional healthcare such as complementary and integrative therapies. Yet, both the NASEM report and practitioners characterize WH care as a multidimensional approach that aligns with definitions of patient-centeredness. In the VA, Whole Health care encompasses patient-centered approaches that focus on what matters most to the veteran and services to support the veteran in achieving their personal health goals. VA’s WH System (WHS) comprises three components: (1) WH pathway, (2) WH clinical care, and (3) well-being programs. Within these components are two types of services. First, core WH services focus on helping patients identify their personal health goals and align treatment with those goals. WH pathway services help patients think about what is most important to them for their health and lives and identify personal health goals they wish to address with their healthcare providers. WH clinical providers engage with patients to align care and treatment with patients’ personal health goals. WH coaches work with patients to engage in self-management to achieve their personal health goals. Second, well-being services include complementary and integrative health (CIH) offerings (e.g., yoga, tai chi, acupuncture, and chiropractic care), and educational classes to support patients’ ability to self-manage their health. In its ideal form, engagement with this system improves patients’ experience by engaging patients in healthcare, aligning care with their personal goals, and providing skills necessary for self-care. These changes, in turn, improve patients’ functioning, achievement of personal goals, and overall health and well-being.