{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T14:36:42Z","timestamp":1781620602359,"version":"3.54.5"},"reference-count":22,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,8,10]],"date-time":"2023-08-10T00:00:00Z","timestamp":1691625600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Learning Health Systems"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Despite the Veterans Health Administration (VA) efforts to become a learning health system (LHS) and high\u2010reliability organization (HRO), interventions to build supportive learning environments within teams are not reliably implemented, contributing to high levels of burnout, turnover, and variation in care. Supportive learning environments build capabilities for teaching and learning, empower teams to safely trial and adapt new things, and adopt highly reliable work practices (eg, debriefs). Innovative approaches to create supportive learning environments are needed to advance LHS and HRO theory and research into practice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>To guide the identification of evidence\u2010based interventions that cultivate supportive learning environments, the authors used a longitudinal, mixed\u2010methods design and LHS and HRO frameworks. We partnered with the 81 VA cardiac catheterization laboratories and conducted surveys, interviews, and literature reviews that informed a Relational Playbook for Cardiology Teams.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The Relational Playbook resources and 50 evidence\u2010based interventions are organized into five LHS and HRO\u2010guided chapters: Create a positive culture, teamwork, leading teams, joy in work, communication, and high reliability. The interventions are designed for managers to integrate into existing meetings or trainings to cultivate supportive learning environments.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>LHS and HRO frameworks describe how organizations can continually learn and deliver nearly error\u2010free services. The Playbook resources and interventions translate LHS and HRO frameworks for real\u2010world implementation by healthcare managers. This work will cultivate supportive learning environments, employee well\u2010being, and Veteran safety while providing insights into LHS and HRO theory, research, and practice.<\/jats:p><\/jats:sec>","DOI":"10.1002\/lrh2.10383","type":"journal-article","created":{"date-parts":[[2023,8,11]],"date-time":"2023-08-11T01:19:30Z","timestamp":1691716770000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Developing a relational playbook for cardiology teams to cultivate supportive learning environments, enhance clinician well\u2010being, and veteran care"],"prefix":"10.1002","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0264-4059","authenticated-orcid":false,"given":"Heather M.","family":"Gilmartin","sequence":"first","affiliation":[{"name":"Denver\/Seattle Center of Innovation for Veteran\u2010Centered and Value Driven Care VHA Eastern Colorado Healthcare System  Aurora Colorado USA"},{"name":"Department of Health Systems Management and Policy University of Colorado, School of Public Health  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7196-8997","authenticated-orcid":false,"given":"Brigid","family":"Connelly","sequence":"additional","affiliation":[{"name":"Denver\/Seattle Center of Innovation for Veteran\u2010Centered and Value Driven Care VHA Eastern Colorado Healthcare System  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Hess","sequence":"additional","affiliation":[{"name":"Denver\/Seattle Center of Innovation for Veteran\u2010Centered and Value Driven Care VHA Eastern Colorado Healthcare System  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Candice","family":"Mueller","sequence":"additional","affiliation":[{"name":"CART Program, Office of Quality and Patient Safety Veterans Health Administration  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8616-4916","authenticated-orcid":false,"given":"Mary E.","family":"Plomondon","sequence":"additional","affiliation":[{"name":"Department of Health Systems Management and Policy University of Colorado, School of Public Health  Aurora Colorado USA"},{"name":"CART Program, Office of Quality and Patient Safety Veterans Health Administration  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0678-4873","authenticated-orcid":false,"given":"Stephen W.","family":"Waldo","sequence":"additional","affiliation":[{"name":"CART Program, Office of Quality and Patient Safety Veterans Health Administration  Washington DC USA"},{"name":"Department of Medicine, Division of Cardiology University of Colorado  Aurora Colorado 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