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Research Highlight

Engaging Patients and Partners in a Stakeholder Council to Improve Patient Care

The Mental Health Quality Enhancement Research Initiative (MH-QUERI) is a national quality improvement and research program within VA's Health Services Research & Development (HSR&D) Service that focuses on the intersection of mental health services research and implementation science. As a leader in the application of evidence-based mental health practices into routine VA care settings, MH-QUERI developed a unique mechanism for partnering with Veteran patients: the MH-QUERI Stakeholder Council. The Council provides a conduit for Veteran inclusion in the design, delivery, and optimization of VA's mental health services.

The Council's purpose is to serve as a critical resource to MH-QUERI investigators. Comprised of Veteran patients, family members, clinical providers, community advocates, and administrators, the Council provides expert opinion to our researchers at multiple points across the research continuum, from project conceptualization, to data interpretation, and finally, to dissemination. In essence, the Council is a highly regarded consultation activity that offers research review and targeted feedback from patients and other stakeholders so that investigators may improve the impact of their research.

Engaging Patients and Partners

The Council was developed in four phases over the past three years. In Phase I, we partnered with Veteran patients of all eras, advocates, and other community stakeholders with the goal of including their voices early in the research process. We also engaged various stakeholders from inside VA—clinical providers, clinic managers, and administrators from local to national levels— to provide a robust view of the myriad layers of VA's mental health service delivery system. We selected stakeholders for the Council based not only on their own experience as Veterans or status as VA employees, but also for their ability to advocate within the characteristic or role for the group they represent. Additionally, we sought members with an active interest in improving VA patient-centered care, with a Veteran-centric mindset, and who possessed a macro and tactical view of population-based mental health improvements. Finally, the heart of a volunteer is also required for our Council as we can only offer volunteers the promise that their time, expertise, and contributions will make a difference for other Veterans seeking VA mental health services.

In Phase II, we collaboratively developed and pilot tested the operational procedures that would guide the Council. After identifying a chairperson, we collaboratively designed processes and procedures that would maintain the Council's Veteran-centric value, and its bi-directional knowledge exchange. The processes focused on how the MH-QUERI staff would administratively support the Council so as to reduce burden on our volunteers, as well as how to share criticism effectively with investigators during the research review process.

As part of this effort, MH-QUERI staff prioritized the list of affiliated investigators selected to present to the Council. Investigators then submitted specific research materials, including an abstract, a grant proposal, a brief slide presentation, and discussion questions. Prior to sharing these materials with the Council, MH-QUERI staff reviewed the materials and encouraged investigators to present in lay language, avoid acronyms, and define the impact of their research for a typical Veteran seeking mental health services in VA.

Improving Patient-Centered Care

In Phase III, we developed an evaluation plan that would assess the nature of the bidirectional partnership, co-production of research, and knowledge exchange between our stakeholders and investigators. Our evaluation plan outlined the data collection processes and evaluation activities that would assess qualitative data on satisfaction, perceived value, diversity, and use of the Council consultation from MH-QUERI investigators. The plan also called for collection of quantitative data on submission and funding success rates from MH-QUERI administrative data. The final phase, currently in progress, focuses on assessing our outcomes.

Initial evaluation results suggest that our Council is a bi-directional mechanism for our Veteran patients and partners to share their perspectives early in the research process. Overall, the stakeholders provide powerful and valuable expert opinion, as one MH-QUERI investigator stated: "...the input from both the primary care physician and the Veteran was extremely helpful because this intervention was to target the attitudes amongst primary care providers and they heard the intervention, and were able to tell me how it would be received and how their emotional reaction or how much of a buy in I would get from the recipient group. And the Veteran's perspective helped me kind of understand the issues that the Veterans face when they are working with their primary care provider."

The MH-QUERI Stakeholder Council is designed to improve patient care, not just on behalf of Veterans, but with Veterans and partners working together. This inclusive approach has the potential to accelerate the implementation of effective interventions into routine clinical practice, and ultimately, to improve the quality of mental health services for our nation's Veterans. Yet, perhaps even more compelling, as one Veteran Council member stated: "In general, it's great to know that this Council exists! [laughs]... as a Vet receiving services, I'm really glad that there's this much thought, and this much care going into, you know, the research that will eventually affect people like me."