Identifying Best Strategies to Implement Patient-Centered Care

BACKGROUND:
Patient-centered care (PCC) includes empowering patients, focusing on the patient-provider relationship, and enabling providers to partner with patients to better meet patient goals. In 2010, VA began to transform VA healthcare to provide personalized, proactive, patient-driven care. Designated VA medical centers – considered early leaders in PCC – became "Centers of Innovation" (COIs), living laboratories of PCC innovations spanning the spectrum from environmental change to personalized health planning to integrative medicine. This paper describes a qualitative study of four early COIs to inform VA leadership about how best to catalyze and sustain change across the system. In 2013, investigators conducted site visits at four large VAMCs, which were established COIs in different regions of the country. All four were urban medical centers providing a wide range of services. Study participants were interviewed and included 108 employees (22 senior leaders, 42 middle managers, 37 frontline providers, and 7 staff).

FINDINGS:

• Investigators identified seven domains that impacted PCC implementation: 1) leadership, 2) patient and family engagement, 3) staff engagement, 4) focus on PCC innovations, 5) alignment of staff roles and priorities, 6) organizational structures and processes, and 7) environment of care.
• Within each domain, multi-faceted strategies for implementing change were identified. These included efforts by leadership at all levels of the organization who modeled PCC in their interactions – and who fostered willingness to try novel approaches to care among staff. Capturing patients' voices, obtaining patient perspectives, and finding out what matters most to Veterans and their families also were essential to selecting, planning, and implementing PCC initiatives.
• Alignment and integration of patient-centered care within the organization, particularly surrounding roles, priorities, and bureaucratic rules, remained major challenges.

IMPLICATIONS:

• Challenges remain for incorporating patient-centered approaches in the context of competing priorities and regulations. Findings from this study were used to create policy-level incentives to change by incorporating the seven domains into VA senior executive performance measures.

LIMITATIONS:

• By the very nature of being Centers of Innovation, facilities studied had already established key leadership support.
• Patient perspectives were not part of this study; future work should include these perspectives to understand how innovations actually impact patient care.

AUTHOR/FUNDING INFORMATION:
This study was partly funded by VA HSR&D's Quality Enhancement Research Initiative. Drs. Bokhour and Fix are investigators at HSR&D's Center for Healthcare Organization and Implementation Research.

Bokhour B, Fix G, Mueller N, et al. How Can Healthcare Organizations Implement Patient-Centered Care? Examining a Large-scale Cultural Transformation. BMC Health Services Research. March 7, 2018;18(1):168.