U.S. Department of Veterans Affairs (VA) mental health clinician perspectives on barriers and facilitators to implementing patient-centered care

Objective: Providing patient-centered care has recently become a priority strategy for many healthcare systems seeking to improve patient experiences and outcomes. Despite general enthusiasm for the idea of patient-centered care, little is known about how it is being delivered in practice, especially in mental health settings. At the Department of Veterans Affairs (VA), efforts to promote patient-centered care in mental health have focused on empowering patients to become active drivers of their care. The main objective of this project was to qualitatively examine VA mental health clinicians’ perceptions of patient-centered care and to identify facilitators and barriers to its full implementation.

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.