Understanding patient-centred care as individuals and as a Collective Provider: a constructivist grounded theory secondary analysis
Background: Although primary care providers are expected to practice in a patient-centred manner within teams, patient-centred care (PCC) tends to be studied within the provider-patient dyad and in a professionally siloed manner, often to the exclusion of interprofessional team relationships. Purpose: To explore how PCC is understood in the context of inter-provider relationships in Shared Mental Health Care teams. Method: Previously collected data formed the basis of a constructivist grounded theory qualitative secondary analysis. Focus group transcripts from six teams were analyzed using constant comparison methods. Coding, memoing and diagramming were used to construct categories and themes. Findings: Providers understood PCC as individuals and as a team. Working with each other over time, these providers developed a shared identity, termed the “Collective Provider,” and embodied in the phrase working together "makes us a better provider". The Collective Provider was situated in a collaboration supportive clinic context and was characterized by well-functioning inter-provider relationships grounded in genuine positive regard. In these conditions, PCC was used in a relationship-enhancing manner within the team. Berger's concept of ideological work is used to explore how providers appeared to define and re-define patient-centred care through talk to arrive at a collective understanding that was meaningful and doable in their immediate circumstances. Conclusions: Where providers operate in ambivalent clinic settings that support PCC in some ways and discourage it in others, attention to the quality of relationships between providers in addition to with the patient may be important to realizing a team-facilitative mobilization of patient-centred rhetoric.
Patient-centred care, interprofessional collaboration, Shared mental health care, Primary care, Qualitative secondary analysis