title: Qualitative analysis of US Department of veterans affairs mental health clinician perspectives on patient-centered care.
abstract: OBJECTIVE
  Enhanced patient involvement in care has the potential to improve patient experiences and health outcomes. As such, large national and global healthcare systems and organizations, including the US Department of Veterans Affairs (VA), have made patient-centered care a primary goal. Little is known about mental health clinician perspectives on, and experiences with, providing patient-centered care. Our main objective was to better understand VA mental health clinicians' perceptions of patient-centered care, and ascertain possible facilitators and barriers to patient-centered practices in mental health settings.
  
  
  METHODS
  Qualitative study of six focus groups conducted in late 2013.
  
  
  METHODS
  Thirty-five mental health clinicians and staff from a large VA Medical Center.
  
  
  RESULTS
  Transcripts were analyzed using an inductive and deductive thematic analysis approach.
  
  
  RESULTS
  Participants described patient-centered care ideally as a process of shared discovery, and expressed general enthusiasm for patient-centered care. Participants described several ongoing patient-centered care practices but conveyed concerns about the practicalities of its full implementation. Participants expressed a strong desire to change the current biomedical culture and policies of the institution that may hinder clinicians' flexibility and clinician-clinician collaboration when serving patients. In particular, clinicians worried about being held responsible for addressing all of the needs or goals that a patient may identify.
  
  
  CONCLUSIONS
  If patient-centered care is to be practiced fully in mental health settings, healthcare institutions need to develop multimodal strategies to enhance clinician-clinician and clinician-patient collaborations to promote and support a focus on discovery and shared accountability for outcomes.
authors.affiliation: Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, PO Box 1034 (R&D66), Portland, OR 97207, USA Mental Health and Clinical Neurosciences Division, VA Portland Health Care System, PO Box 1034 (R&D66), Portland, OR 97207, USA Department of Psychiatry, Oregon Health & Science University, 3181 Sam Jackson Park Rd, Portland, OR 97239, USA.
authors.forename: Steven K
authors.initials: SK
authors.lastname: Dobscha
authors.affiliation: Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, PO Box 1034 (R&D66), Portland, OR 97207, USA.
authors.forename: Risa
authors.initials: R
authors.lastname: Cromer
authors.affiliation: Mental Health and Clinical Neurosciences Division, VA Portland Health Care System, PO Box 1034 (R&D66), Portland, OR 97207, USA.
authors.forename: Aysha
authors.initials: A
authors.lastname: Crain
authors.affiliation: Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, PO Box 1034 (R&D66), Portland, OR 97207, USA Mental Health and Clinical Neurosciences Division, VA Portland Health Care System, PO Box 1034 (R&D66), Portland, OR 97207, USA Department of Psychiatry, Oregon Health & Science University, 3181 Sam Jackson Park Rd, Portland, OR 97239, USA.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Denneson
mesh_terms: D003299:Cooperative Behavior; D004777:Environment; D017144:Focus Groups; D006282:Health Personnel / Q000523:psychology*; D006694:Holistic Health; D006801:Humans; D008605:Mental Health Services / Q000458:organization & administration* / Q000592:standards; D015279:Organizational Culture; D010358:Patient Participation; D018802:Patient-Centered Care / Q000458:organization & administration* / Q000592:standards; D036301:Qualitative Research; D058996:Quality Improvement; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration* / Q000592:standards
keywords: clinician-patient relationship; mental health; patient-centered care; veteran