Sex did not play a significant role in how respondents answered questions regarding VA excitement or innovation. However, there was a statistically significant difference in how male and female respondents answered the predemonstration question about their plans to continue VA employment, according to the Wilcoxon rank sum test. Predemonstration, female respondents had a mean score of 4.1, which was 6% lower than the 4.4 score of male colleagues (P = .04). Veteran status did have an impact on how respondents felt about VA innovation, and their plans to continue employment at VA. After the demonstration, veteran staff felt the VA was more innovative compared with nonveterans: 4.7 vs 4.4, respectively, a 6% difference (P = .02) Similarly, for the continued VA employment question, veterans had a mean score of 4.8 vs 4.4 for nonveterans, an 8% difference (P = .03) These results suggest that the demonstration had more of an impact on veteran employees vs nonveteran employees.
Unpaired Questions
There were 2 structured unpaired postdemonstration questions. Respondents agreed that similar technology would impact veteran health care with mean (SD) of 4.6 (0.6) and a median score of 5 on a 5-point Likert scale. Respondents also agreed on the importance of implementing similar innovations with mean (SD) of 4.7 (0.5), and a median score of 5.
The survey asked how this technology could benefit their hospital service department and had 64 responses. Forty-six respondents saw applications for education or patient care/surgery. Other responses shared excitement about the technology and its potential to positively impact patient education. There were 37 responses to the open-ended question: 21 respondents expressed excitement for the technology, and 10 respondents reiterated that the demonstration would be of benefit to patient care/surgery and training.
Discussion
Successful development, design, and deployment of any new health care tool depends on leveraging insights from the employees that will be using and supporting these systems. Correspondingly, understanding the impact that advanced technologies have on health care employees’ satisfaction, morale, and retention is critical to our overall institutional strategy. Our findings show that a one-time experience with AR/MR technology elicited positive employee reactions. Of note, the survey revealed statistically significant improvements in staff’s view of the VA, with the greatest positive impact for questions about innovation, followed by excitement to work at the VA, and likelihood to continue work at the VA. It is very disruptive and costly when health care employees leave, and improving employee satisfaction and morale is important for better patient care and patient satisfaction, which is priority for VAPAHCS leadership.57-62
The paired predemonstration and postdemonstration scores were similarly high, nearing the top threshold available for the Likert scale (4.3 to 4.5). Furthermore, the least incremental improvement for these responses was observed for topics that had the highest initial baseline score. Therefore, the improvements observed for the paired questions may have more to do with the high baseline values.
Of additional interest, the self-reported likelihood of continuing to work at the VA increased the most for female employees, veteran employees, and employees with the least number of years at the VA. These demographic differences have important implications for VA staff recruitment and retention strategies.62 The unpaired questions about the impact on veteran care and whether the VA should continue similar work demonstrated extremely high support with median scores of 5 for both questions. The free-text postdemonstration responses also demonstrate similar positive themes, with a disposition for excitement about both the training and patient care applications for this technology. In addition, respondents felt strongly that this and other similar technologies will positively impact the health care for veterans and that the VA should continue these efforts.
Strengths and Limitations
A strength of this assessment is the ability to evaluate survey responses that were systematically collected and matched from the same individual immediately before and after exposure to the new technology. The free-text responses provided additional important information that both confirmed the results and provided additional valued supplementary guidance for future implementation strategies, which is critical for our translational implementation goals. An additional strength is that the voluntary surveys were managed by non-VAPAHCS colleagues, limiting potential bias. Importantly, the number of respondents allowed a statistically significant assessment of important health care employee metrics. These results have emphasized how being part of an innovative organization, and the introduction of advanced AR/MR technology, improve employees’ satisfaction and morale about where they work as well as their intention to stay at their institution.
A limitation of this assessment was the lack of comparative data for employee acceptance of other technologies at VAPAHCS. This limits our ability to differentiate whether the strong positive results observed in this evaluation were a result of the specific technology assessed, or of new and advanced health care technology in general. Nonetheless, our unpaired questions, which received extremely high scores, also included participant questions about comparing the system with other similar technologies. This assessment was also focused on veteran care, which limits generalizability.
Conclusions
One-time exposure to advanced AR technology for health care significantly increased employee morale as measured by excitement about working at the VA as well as employee intention to continue employment at the VA. These collateral benefits of the technology are particularly important in health care because our employees are our most important asset and improving employee morale equates to better patient care. Positive impacts were most pronounced for women employees, newer VA employees, and employees who are also veterans. These more detailed insights are also positioned to have a direct impact on employee recruitment and retention strategies. Additional valuable insights regarding the most applicable use of the technology in the clinical setting were also obtained.
Acknowledgments
We thank Andrew Spiegelman, Hyewon Kim, Jonathan Sills, and Alexander Erickson for their assistance in developing the survey questions. We also thank Jason Rhodes and Mark Bulson for traveling to our facility to assist with managing the anonymous surveys during the demonstration event.