Key Organizational Characteristics Associated with Providing Evidence-based, Patient-Centered Medical Care in VAMCs

BACKGROUND:
Two major trends in healthcare over the past 10 years have been the moves to evidence-based practice (EBP) and patient-centered care (PCC). It might seem that combining effective EBP and PCC could only enhance patient care; however, many argue that there is a fundamental tension between these goals. Additionally, the provision of PCC, with its emphasis on being responsive to individual patient and family preferences, needs, and values can potentially conflict with the delivery of effective and efficient care via standardized processes of EBP. This study assessed the relationship between EBP and PCC by seeking to identify specific behavioral and process mechanisms, along with organizational characteristics that distinguish medical centers that are able to provide inpatient care that is both evidence-based and patient-centered from those where performance is either mixed or low in both domains. Investigators analyzed interview data from 142 employees at 12 VAMCs selected based on EBP and PCC performance (high, low, or mixed).

FINDINGS:

• High-performing sites for both EBP and PCC:
  • Exhibited organizational cultures of empowerment where EBP and PCC expectations were both emphasized;
  • Provided formal and informal institutional supports and structures for PCC and EBP; and
  • Fostered multidisciplinary, multidirectional approaches to care and communication that facilitated delivery of both EBP and PCC.
• Low-performing sites:
  • Exhibited a passive or sometimes punitive culture in which there was a lack of accountability, blaming, and resistance to change.
  • Aspired to improve clinical performance and patient-centeredness, but clinicians often felt bound by institutional structures and systems that were bureaucratic and constrained their ability to deliver their preferred type of care.

IMPLICATIONS:

• Senior leaders should consider the current organizational culture to determine levels of empowerment and support. Leaders and managers can then introduce and support policies and procedures to deliver strong, consistent expectations that all staff are responsible for delivering care that is both evidence-based and patient-centered.

LIMITATIONS:

• All sites were acute care VAMCs of medium to high complexity, which may limit generalizability to healthcare organizations that are providing more complex levels of care.

AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (IIR 07-244). Ms. Engle, Dr. Mohr, and Ms. Leyson are part of HSR&D’s Center for Healthcare Organization and Implementation Research (CHOIR). Dr. Meterko, formerly of CHOIR, is a member of the SHEP patient experience survey team within the VHA Office of Reporting, Analytics, Performance, Improvement and Deployment (RAPID).

Engle R, Mohr D, Holmes S, Nealon Seibert M, Afable M, Leyson J, Meterko M. Evidence-Based Practice and Patient-Centered Care: Doing Both Well. Health Care Management Review. June 20, 2019; Epub ahead of print.