Document Type

Doctoral Project

Publication Date



In 2015, the Centers of Disease Control and Prevention reported that the most common, costly but preventable health problems are heart disease, stroke, cancer, diabetes, obesity, and arthritis. Literature shows preventable chronic diseases have increased in the current healthcare system. Healthcare leaders are calling for a change in the current faulty healthcare delivery system to personalized healthcare. A patient-centered approach focuses on the health gains that can be made in the prevention and treatment of chronic disease with a higher level of patient engagement.

The Veterans Health Administration (VHA) is advocating patient-centered care (PCC) to focus on the health gains that could be made in the prevention and treatment of chronic disease with a higher level of patient engagement. To aid in empowering veterans to take ownership of their healthcare the VHA has endorsed use of Personalized Health Plans (PHP). VHA directed primary care healthcare professionals to use a patient-centered approach to encourage veterans to make a holistic self-evaluation then create personalized goals or PHP, focusing on their whole being, not just their medical illnesses to improve health and wellbeing. However, patient-centered care with documentation of PHPs across the VHA has met some resistance. In fiscal year 2014, October 1, 2013 to September 30, 2014, a midwestern VHA primary care administration, reported their clinics only initiated 66 PHPs from 32 patient aligned care teams (PACTs) that each saw approximately 270 veterans a day. The administration required an immediate action plan to promote patient-centered care and increase the number of PHPs.

To intervene in this dilemma, Lewin’s Change Theory and the Institute for Healthcare Improvement’s Model for Improvement, known for accelerating process improvement, were used as the framework for this process improvement project to evaluate if the utilization of a change agent would facilitate implementation of PHP. The change agent used multiple strategies of guidance, facilitation, and inspiration in three successive one-month Plan-Do-Study-Act cycles to promote PHP among 29 patient aligned care teams (PACTs). The use of a change agent did promote the implementation of PHP. After the change agent became involved the total number of PHPs increased across these midwestern primary care clinics. However, the increase in PHPs per PACT was not as high as desired. The aim was for PACTs to initiate 3 PHPs a week or 12 PHPs a PDSA Cycle. Over the three-month intervention, the aim of 12 PHPs initiated per PACT a month occurred just ten times, only 39% of the aim was met. Several factors could have restrained PACTs from rapidly increasing their numbers of PHPs, including time restraints and electronic health record limitations. Recommendations to facilitate PHP implementation are to decrease barriers and increase facilitators to this change in practice.

Included in

Nursing Commons