U.S. Department of Veterans Affairs (VA) mental health clinician perspectives on barriers and facilitators to implementing patient-centered care
Methods: Thirty-five mental health clinicians and staff from a large VA Medical Center, representing a range of professions and clinics, participated in six qualitative focus groups. The focus group guide discussion topics were: 1) familiarity with patient-centered care principles and models, 2) impact of patient-centered care principles on practice, 3) barriers to implementation, and 4) opportunities for system-level improvements. Focus group transcripts were analyzed using an inductive and deductive thematic analysis approach.
Results: In general, clinicians discussed the gap between their enthusiasm for patient-centered care as an idea and their capacity to implement it in practice. 1) Clinicians were familiar with principles of patient-centered care and supported efforts to create clinician-patient relationships that are more balanced, collaborative, and focused on shared responsibility and accountability. 2) Clinicians often described their patient-centered care practices as a “dance” of knowing when to let patients take charge of their care, and when to step in to protect patients from potential harms. 3) Clinicians identified considerable barriers to fully implementing patient-centered care, including patient and clinician frustrations with navigating the VA healthcare system, limited resources, and uncomfortable therapeutic environments. 4) Clinicians expressed the need for increased system-wide support and further opportunities to collaborate with other clinicians as necessary facilitators to implementing patient-centered care.
Conclusion: Healthcare systems interested in implementing patient-centered care principles in mental health settings should develop multi-modal strategies that support clinician-clinician collaboration and provide patients with the resources necessary to act as drivers of their healthcare.
Learning Areas:Administration, management, leadership
Describe VA mental health clinician perceptions of patient-centered care. List common barriers to implementing patient-centered care in mental health settings. Discuss system-level strategies for facilitating patient-centered care implementation.
Keyword(s): Veterans' Health, Patient-Centered Care
Qualified on the content I am responsible for because: I am a Research Assistant at the Center to Improve Veteran Involvement in Care (CIVIC) at the Portland VA Health Care System, where this project was conducted. I have contributed to the interpretation of data from this project, and I have 2 years prior experience collecting and analyzing data from quality improvement projects at the University of Wisconsin-Population Health Institute.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.