Leadership coaching as an implementation strategy to enhance adoption of a relational playbook and team well-being: a pilot randomized clinical trial in cardiology teams

Abstract Background Supportive learning environments are foundational to clinician well-being, workforce retention, and delivery of high-quality care. Prior evidence suggests that the Relational Playbook, an evidence-based leadership development program, can cultivate these environments. Leadership coaching may further enhance Playbook implementation, but its effectiveness has not been tested. The objective of this study was to assess the acceptability, appropriateness, and feasibility (AAF) of the Playbook and explore leadership coaching as an implementation strategy to support Playbook adoption and team well-being. Methods A pilot site-randomized trial was conducted in six Veterans Health Administration (VA) cardiac catheterization labs. Sites were randomized (3 intervention, 3 control) to receive the Relational Playbook with or without six months of leadership coaching. AAF were assessed using a validated implementation instrument (Weiner, 2017) using 12 Likert-type items (range 1–5; higher scores reflect greater AAF) among participating managers at study completion. Secondary outcomes of team learning environment and well-being were assessed through pre-post intervention surveys by managers and staff. Difference-in-difference (DiD) analyses were conducted descriptively because of the small sample size. Adoption of Playbook practices, coaching experience, and implementation perceptions were assessed through surveys and qualitative interviews. Results Ten managers enrolled and six completed all aspects of the study (60% retention), representing all six sites. Among completers, AAF ratings for the Playbook were high with median scores greater than 4 across domains. Learning environment and well-being analyses were based on 41 baseline and 20 follow-up survey responses. Compared with control sites, intervention sites showed a relative reduction in burnout (DiD = -0.4) and intent to leave (DiD = -0.6) and a relative increase in job satisfaction (DiD = + 1.1). Adoption of Playbook practices was greater in intervention sites compared to controls. Participants reported that coaching provided real-time feedback, facilitated Playbook adoption, and supported team professional development and well-being. Conclusions Leadership coaching enhanced Playbook adoption and preliminary data suggested a positive shift in cardiology team well-being. These findings support conducting larger-scale trials and implementing the combined approach across additional high-intensity clinical departments to strengthen learning environments and workforce resilience. Trial registration Registered on 6/13/2024; ClinicalTrials.gov Identifier: NCT06456021.