My proposed DNP project is to increase access to and utilization of mental healt

My proposed DNP project is to increase access to and utilization of mental health services for Veterans through a telemedicine platform by increasing utilization of mental health screening and referrals by Primary and Specialty Care Telemedicine Providers. I currently work for the VA as a telemedicine provider, covering seven healthcare systems within VISIN 21 under a relatively new program called Clinical Resource Hub (CRH). To quickly summarize, CRH is an initiative by the Department of Veterans Affairs to provide Veterans with better access to care; these Veterans may live in rural areas, have transportation issues, or the service is just not available in their local VA, and CRH helps to fill that void by providing telemedicine care (Department of Veterans Affairs, 2022). In Week 1, we used self-reflection and other assessment tools to identify our leadership and management strengths and weaknesses; my leadership strengths lie in developing collaborative relationships with others and my determination to practice with ethical integrity. These are important tools when working in a large interdisciplinary team encompassing healthcare providers, administrators, and ancillary staff across multiple US States and territories. Becoming a transformational leader involves actively incorporating leadership competencies into practice; per Broome and Marshall (2021), a competent leader practices five competencies, communication and relationship-building, knowledge of the healthcare environment, leadership, professionalism, and business skills. One of the biggest anticipated challenges I would face would be managing meetings or collaboration sessions across four different time zones, especially when collaborating with colleagues in Guam, who are 17 hours ahead. To engage the project team through leadership competencies, I would work with colleagues to identify the best meeting strategy, maintain professionalism, and not push providers to meet outside of regular working hours unless they give permission. I would also collaborate to understand each facility’s healthcare environment, particularly focusing on available resources. For example, most of my patients in Guam do not have internet access, so they go to the local VA clinic for telemedicine visits. Among these patients, the best strategy would be to build a strong professional relationship with the nurses and providers in that clinic so that I know who to IM when emergency care during a crisis is needed and who to best refer a patient in need of mental health services. In addition to maintaining competence through building professional relationships, I would also use mindfulness when leading my team, ensuring that personal stressors or emotions do not negatively impact my ability to be an active listener (Putri & Meria, 2022). Mindfulness is described as maintaining openness and being aware of your thoughts, emotions, and influences by internal and external stressors; it is an important factor in maintaining emotional intelligence as personal thoughts, emotions, and stressors can negatively affect one’s relationship with others (Sanyal & Rigg, 2020). One approach I currently practice is quiet self-affirmation and shutting off distractions. Before attending a meeting, I turn off any phones or electronic devices and close any open tabs or computer windows so that I am fully participating in a video meeting, even if I find it boring. I also quietly repeat to myself that the world will not end, that I am not neglectful, and that my patient(s) will not suffer if I don’t finish my notes and orders immediately or wait to answer non-critical questions. Practicing mindfulness is important in being an effective transformational leader; how can I fully listen to other individuals’ needs, suggestions, and questions if I am distracted by alerts popping up or contemplating all the tasks I need to complete. In the VA, mental health concerns have been a top priority since the 1940s, so I don’t anticipate struggling to sustain my practice change when collaborating with administrative personnel; my biggest barrier to sustaining my proposed practice change would be the clinical staff. As a clinician, I understand the anticipated frustration; there is enough stress trying to maintain clinics across multiple sites, understanding and following Pharmacy, Pathology, and other resource guidelines and parameters (which vary from facility to facility), and navigating the complex chain of command at each site. Therefore, my strategy to influence a good environment among clinicians to sustain my practice change will involve collaborating with them before, during, and after implementation to address concerns and find the most sustainable practice, for example as part of the screening process, I would trial if having a shortened version of the Columbia Suicide Severity Rating Scale (CSSRS) incorporated into the provider note is acceptable, or having a direct mental health professional assigned to specific site or specialty, in case of a mental health crisis during a visit. Either way, I would want to ensure that the environment I create is open, non-judgmental, and safe for colleagues to voice their opinions and make suggestions.
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