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Dobscha SK, Cromer R, Crain A. VA Mental Health Clinician Perspectives on Education and Tools to Facilitate Patient-Centered Care. White Paper Report for VA Office of Patient Centered Care and Cultural Transformation. 2014 Jan 2.
The VA has identified patient-centered care as a high priority; shifting current VA culture to a culture that is more patient-centered is now part of VA's national strategic plan. In 2011, the VA created the Office of Patient Centered Care and Cultural Transformation (OPCC), which provided funding in FY2013 for the project described here. OBJECTIVES OF PROJECT: 1) Identify VA mental health clinician perceptions of what it means for care to be patient-centered; 2) identify existing barriers to providing patient-centered care and ideas for integrating patient-centered principles into care; 3) identify specific educational content and education modalities, and tools and systems supports that would facilitate delivery of patient-centered care; 4) explore VA mental health clinician reactions to current versions of the OPCC Wellness Wheel (WW) model and Personal Health Inventory (PHI) tool, with respect to structure and content, methods and feasibility of using these tools, and understanding and responding to information generated by the PHI. METHODS: In the latter half of FY2013, six focus groups were conducted involving 35 mental health clinicians and staff who work in the Portland VA Medical Center Mental Health and Clinical Neurosciences Division. Participants represented a range of professions and clinical sessions. Participants were shown PHI version 18 as part of the process. Sessions were transcribed, and the analysis utilized techniques from grounded theory and thematic analysis. KEY FINDINGS: We identified four overarching themes. The first is that there is general enthusiasm among mental health clinicians for, and existing investment and activity in, patient-centered care. Second, clinicians expressed concern that there is a lack of sufficient or appropriate resources to address the practicalities of optimal implementation of patient-centered care. The third theme regards expectations. Clinicians worry there will be a mandate for them to implement the full WW/PHI on a substantive scale, which would be challenging given resource limitations and the need they see for more systemic changes. They also worry that systematically using the full WW/PHI could be counterproductive with some patients whose needs, priorities, and orientations may not be well-aligned with the WW/PHI framework. The fourth theme regards an ongoing need to change institutional culture, policy, and structure that currently limit the ability of clinicians to be flexible, and to efficiently and to optimally collaborate.