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Evidence-based practice and patient-centered care

Doing both well

Engle, Ryann L.; Mohr, David C.; Holmes, Sally K.; Seibert, Marjorie Nealon; Afable, Melissa; Leyson, Jenniffer; Meterko, Mark

doi: 10.1097/HMR.0000000000000254
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Background Health care organizations increasingly strive to deliver care that is both evidence based and patient centered. Although often complementary, fundamental contradictions may exist between these goals, and the organizational culture and infrastructure necessary to be successful in one domain may inherently diminish performance in the other.

Purpose We assessed the relationship between evidence-based practice (EBP) and patient-centered care (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.

Methodology/Approach We analyzed interview data from 142 employees at 12 Veterans Affairs Medical Centers selected based on EBP and PCC performance (high, low, or mixed) using a priori constructs consistent with organizational literature, as well as emergent themes.

Results We confirmed that tensions may arise when attempting to deliver both EBP and PCC and found unique characteristics of organizations that do both well. High-performing sites exhibited organizational cultures of empowerment where both EBP and PCC expectations were emphasized; provided formal and informal institutional supports and structures with regard to PCC and EBP; and fostered multidisciplinary, multidirectional approaches to care and communication that facilitated delivery of both EBP and PCC.

Conclusions and Practice Implications Organizations that excel in providing both EBP and PCC exhibit unique characteristics and processes. Recognizing that some characteristics such as culture are difficult to change, these findings nonetheless highlight areas that could be enhanced by medical centers striving to deliver care that is both evidence based and patient centered.

Ryann L. Engle, MPH, is Research Health Scientist, Senior Project Manager, Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs, Boston, Massachusetts. E-mail: ryann.engle@va.gov.

David C. Mohr, PhD, is Investigator, Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs, and Research Assistant Professor, Department of Health Law, Policy & Management, Boston University School of Public Health, Massachusetts.

Sally K. Holmes, MBA, is Co-Investigator, Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs, Boston, Massachusetts (retired).

Marjorie Nealon Seibert, MBA, is Senior Project Manager, Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs, Boston, Massachusetts (retired).

Melissa Afable, MPH, is Project Manager, Partners HealthCare, Department of Quality, Safety and Value, Department of Veterans Affairs, Boston, Massachusetts.

Jenniffer Leyson, MA, is Analyst, Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs, Boston, Massachusetts.

Mark Meterko, PhD, is Senior Survey Methodologist, VHA Office of Reporting, Analytics, Performance, Improvement and Deployment, Department of Veterans Affairs, and Research Associate Professor, Department of Health Law, Policy & Management, Boston University School of Public Health, Massachusetts.

This study was funded by the U.S. Department of Veterans Affairs Grant IIR 07-244 and received institutional review board approval from the VA Central Institutional Review Board. The contents of this article are those of the authors and do not represent the views of the U.S. Department of Veterans Affairs or the U.S. Government. Findings presented in this article were presented as the Best Organizational Behavior and Management Abstract at the June 2015 AcademyHealth Annual Research Meeting in Minneapolis, MN. The authors would like to thank the larger research team.

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

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