Table 5 Most salient constructs, description of data collected, recommendations developed, and operational tactics

Patient needs and resources

Involvement of patients and their families was viewed as a critical component

Engagement of patients can occur through

Informal and formal feedback mechanisms (such as surveys, interviews, or focus groups and consumer panels or counsels)

Providing information to patients and families about new programs/treatments

Capitalize on formal feedback sessions for Veterans engagement

Establish informal mechanisms to engage Veterans

Leadership engagement

Active and visible support from all levels of leadership facilitated implementation, and encouraged staff buy-in

Leadership engagement can occur through

Actively and openly supporting PCC

Supporting/encouraging staff involvement

Seeking and acting upon staff feedback

Identify leaders to be dedicated to PCC

Identify a core cadre of leaders who will be responsible for the cultural transformation

Structural characteristics

Organizational structures, processes, rules, were significant barriers (i.e. role clarity, misaligned performance measures)

Organizational structure and barriers can be addressed by

Clarify goals of the program, expectations for staff

Aligning performance measures with program goals and expectations of staff

Provide examples of how you have fostered flexibility to support PCC

Identify areas where you built on synergies with other priority initiatives

Knowledge and beliefs of the intervention

Staff reported challenges incorporating PCC into their regular practice, often not understating their role in PCC

Clarifying roles and priorities of PCC for staff can be achieved by

Providing examples of how PCC should be integrated into daily

Ensuring that staff are accountable for incorporating PCC into practice

Provide clear examples of embodying PCC

Adapt performance measures for PCC to align staff work with institutional priorities

Engaging staff

Providing opportunities for staff to engage and providing feedback on efforts were essential for staff buy-in

Enculturating staff can be achieved by

Targeted training supporting expectations that all staff should embody the principles and incorporate them into every day

Infuse PCC messages everywhere

Showcase support for creative and appropriate risk-taking in development of new PCC approaches among frontline staff

Champions and/or formally appointed champions

Naturally emerging champions and use of mid-level champions facilitated innovations derived from senior leadership

Fostering innovations and new ideas generated by staff can be achieved by

Supporting naturally emerging champions and/or establishing mid-level champions

Developing strategies to support innovations with feasible implementation

Identify middle managers as clinical champions to foster implementation of senior management-initiated innovation