Tailoring the Relational Playbook for Cardiology Teams to the Rural Hospital Medicine Setting: A Multi-Method Pre-Implementation Evaluation.

PURPOSE: The Relational Playbook for Cardiology Teams is a 6-month, evidence-based leadership development program designed to foster supportive learning environments within the Veterans Health Administration (VA). The Playbook features 50 leadership practices and resources, including readings, clinical examples, videos, and podcasts for flexible, asynchronous learning. Participants complete monthly independent study and implement 11 interventions during team meetings or one-on-one interactions. While rural healthcare settings may benefit from the Playbook, adaptations are needed to ensure acceptability, appropriateness, and feasibility. This study aimed to tailor the Playbook for rural hospital medicine using a theory-informed multi-method pre-implementation approach.

METHODS

Clinical leaders in medicine, nursing, social work, and pharmacy were recruited from three rural VA hospitals. Facility-level data were drawn from the 2023 VA Support Service Center Capital Assets database and the VA Hospital Medicine Survey. Observational data from site visits were collected using a structured template and analyzed through team-based rapid qualitative content analysis.

FINDINGS: In 2024, we conducted three site visits at intermediate-complexity VA hospitals serving rural Veterans. Clinical leaders at each site reported potential barriers to engagement, including leadership instability, physician burnout, and limited time for professional development. Tailoring strategies were recommended, including expanding recruitment to all clinical leaders, streamlining site visits, and using publicly available data to contextualize site-specific challenges.

CONCLUSION

A multi-method pre-implementation approach enabled effective adaptation of the Playbook, improving its relevance for rural settings. Early engagement and flexible implementation are key to successful adaptation. Future evaluation will assess impact on team dynamics and Veteran care.