Transforming healthcare: Whole Health in the VA—progress, challenges and cultural shifts

Abstract: More than 20 years ago the National Academy of Sciences, Engineering, and Medicine (formerly Institute of Medicine) released a comprehensive report on the state of health care in the United States entitled Crossing the Quality Chasm: A New Health System for the 21st Century. From this call to action grew Whole Health, a system of care wherein quality health care consists of far more than the reactive biomedical delivery model that had become conventional in American health care systems. The transformation of the VA health care system into one centered around the tenets of Whole Health has recently accelerated in response to the national opioid crises, as well as the many challenges associated with the COVID-19 pandemic. The study by Wu et al. describes modifications made by providers to facilitate engaging patients in Whole Health virtually. As reported by Kligler et al., VA has developed over 50 Whole Health educational courses which continue to be refined for both veterans and providers. Over 30,000 VA employees have participated in these educational efforts, and more than 56% of providers now report they actively incorporate Whole Health in the care they deliver to veterans. While Whole Health is much more than referral to any individual service, CIH integration does continue to be a focus of Whole Health, particularly ensuring that those with chronic musculoskeletal pain are introduced and connected to CIH therapies as part of their health care experience. One of the studies6 in this special issue found that the 18 Flagship VA Medical Centers which prioritized implementing Whole Health observed a 46% increase in use of CIH therapies compared to a slower secular increase of 17% over the same time-period across other VA Medical Centers nationally. Overall, the manuscripts in this special issue demonstrate a wide range of ways in which Whole Health is transforming care for veterans and staff across VA. Many challenges remain in fully achieving the vision VA has for Whole Health and its systemwide implementation that requires overcoming the reactive biomedical health care culture that remains deeply entrenched. How Whole Health is integrated into care delivery for both providers and patients will continue to evolve. The articles in this special issue highlight the ongoing exploration of the range of patient and provider well-being outcomes potentially impacted by Whole Health, and the growing evidence base for Whole Health as we learn as a health system how to work to redesign and improve care for veterans.