Table 3.

Representative quotes for high- and low-performing sites on patient-centered care (PCC)

Theme	High-performing characteristics and quotes	Low-performing characteristics and quotes
Interactions	Relational: “Through conversation, it was clear he really didn’t want any of that. So, we were able to arrange for him to go home with Hospice without any further kind of medical diagnosis, intervention, which on the other hand, you can imagine he would have been in the hospital for weeks, very well may have died in the hospital. He actually died 2 weeks later at home with his family, which from my perspective is great. We were able to make and reach those goals for that patient, which may not have been my goals or a physician’s goals.” Site B-HEBP/HPCC	Transactional: “We are very much a culture of process instead of service…we’re transactional versus transformational. Putting on the armband for a new inpatient, we put it on them and that’s it. And that’s a transaction. Versus, ‘…We put this on you for safety reasons, so we can always identify that you are who you’re supposed to be and that any test you take is associated with you…it’s an important part of us keeping you safe.’ A lot different type of interaction than put this on you and then move to the next area.” Site J-LEBP/LPCC
PCC implementation	Integrated: “Our mission to honor Veterans with health is all over the building. Reinforce that at every opportunity. In inpatient units, [nursing home] area, outpatient clinics have been largely redesigned to be more accessible…We embrace caregivers as partners in the care for Veterans…We involve veterans and families in almost everything we do…I have a veteran who is a voting member on the governing board for our health system…at every meeting he has a standing agenda item…to remind all of us, in particular our providers, why we show up for work in the morning.” Site H-LEBP/HPCC	Individual: “I’m an intensive care physician, so when I’m in ICU, I try to model that for residents and fellows and work collaboratively with our Palliative Care partners. Oftentimes patients are identified for Palliative Care when come into the ICU. So, I try to do that personally there, facilitate those things I can that would allow PCC to develop.” Site D-HEBP/LPCC
Perspective	Opportunity: “I really do believe we have a culture in Nursing directed at PCC and patient safety. So, when they see an issue that relates to safety and patient satisfaction, they’ll put a team together, develop a process.” Site B-HEBP/HPCC	Barrier: “They’ve been so task oriented, ‘I have to do this, don’t think outside the box.’ Doesn’t afford them the opportunity to say, ‘Hey maybe we should get the patient out of the bed because of his COPD.’ They don’t have the opportunity to do that.” Site F-HEBP/LPCC

Note. ICU = intensive care unit; COPD = chronic obstructive pulmonary disease; HEBP = high evidenced-based practice; LEBP = low evidence-based practice; HPCC = high patient-centered care; LPCC = low patient-centered care.