STRATEGIES FOR PATIENT-CENTERED CARE IMPLEMENTATION IN INDEPENDENT MEDICAL PRACTICES

STRATEGIES FOR PATIENT-CENTERED CARE IMPLEMENTATION IN

INDEPENDENT MEDICAL PRACTICES

Section 1: Foundation of the Project

Patient-centered care is a concept recognized globally and has different iterations

that many different health organizations have adopted. According to Ortiz (2019), across

the country, there are over 1,600 established nurse-led (managed) health centers that

“meet the needs of patients nationally and globally.” The primary focus was to explore

the patient’s involvement in the decision-making process and be more active when it

came to their health management. In health care delivery and health policy, a

patientcentered approach affirms the ethical principles of respect for persons and justice

while striving to make the health system more responsive to patients’ values and

preferences (Gusmano et al., 2019). The governance of patient-centered care requires that

healthcare organizations have a system in place to implement the patient-centered care

initiative. Governance represents how each country, province, state, or medical clinic may

administer, manage, and interpret policies and guidelines to support healthcare practices.

A distinction within is that it is foremost an equitable model of care, with an ideal

outcome being patient-centered care, where patients are respected (Lau et al., 2019).

These governances apply whether it is a physicians’ group, individual medical physician,

or nurse practitioner.

Background of the Problem

Patient-centered care is an initiative with the goal of allowing patients and their

family members to be involved in the decision-making process. As stated by Ortiz (2019),

congruence is vital because health policy decision-making is guided by beliefs and values

about humans and health; nursing knowledge should contribute significantly to the

standards of practice that are set forth in policies. It is mandated that all physicians adhere

to the patient-centered care requirements. The implementation of the mandate is costly.

Institutes such as physician’s groups and hospitals have the financial latitude to share the

costs essential to meet the requirements, while for independent physicians,

implementation of requirements to meet the mandate of patient-centered care is a

financial burden. Concierge medicine is an independent physician who charges an annual

fee to provide medical services to individuals (Majette, 2009). This type of practice has

challenges that are different from those of traditional independent medical practitioners.

According to Majette (2009), concierge physicians’ patients have additional benefits such

as direct access to their physician via email, text, phone, same-day or following-day

appointments, longer, more personalized appointments, and house calls. With the shortage

of healthcare professionals, it becomes more difficult to identify root causes and best

practices and explore alternative support resources. These factors have created a change

in communication between healthcare providers and their patients.

Business Problem Focus and Project Purpose

The specific business problem was some independent medical practice

professionals lack strategies for implementing patient-centered care, which can improve

quality patient care and practice profitability. Therefore, the purpose of this qualitative

pragmatic inquiry was to explore strategies some independent medical practice

professionals used to implement patient-centered care, ensuring quality patient care and

practice profitability.

The targeted population consisted of independent healthcare professionals

experienced in patient-centered care environments who had implemented successful

strategies that sustained their operations beyond 3 years. I used purposive sampling to

select at least six participants and gained access to them through professional associations

and social networks. To collect the data, I used semistructured interviews, publicly

available documentation, artifacts, and testimonials. The conceptual framework for this

study was patient-centered care, developed by Balint (1969) in 1969.

Research Question

What strategies do some independent medical practice professionals use to implement

patient-centered care to improve quality patient care and practice profitability?

Assumptions and Limitations

Assumptions

An assumption is an understanding of an individual based on their perspective

(Ravitch, 2020). There were several assumptions that were made about this study while

exploring the implementation of patient-centered care. First, the respondents were

knowledgeable and experienced in implementing patient-centered care. Another was that

the respondents had some direct interaction with the patients. Finally, I also assumed the

respondents’ understanding of the financial impact that implementing patient-centered

care has on their practice.

Limitations

A limitation creates constraints to scale to a manageable size (Ravitch, 2020).

This research study had three main limitations. First, this study was limited by the

location and patient population due to the suburban metro areas it was conducted. The

study was conducted in a higher populated area poses different challenges and

considerations. Second, the entities in this study were physician’s groups, medical

professionals, and independent physicians in general practice in suburban metro areas.

Unfortunately, the sample size was not large enough to compare the three entities.

Transition

In this section, I reviewed the purpose of this qualitative pragmatic inquiry, which

was to explore strategies some independent medical practice professionals used to

implement patient-centered care, ensuring quality patient care and practice profitability.

In Section 2, the study examines peer-reviewed articles that provided perspectives of

various healthcare professionals concerning the implementation of patient-centered care,

quality of care, and entities that provided patient support. In Section 3, the study focuses

on the Study Research Methodology, and Section 4 presents the Findings and

Conclusions of this study.

Section 2: The Literature Review

A Review of the Professional and Academic Literature

This qualitative pragmatic inquiry explored strategies for some

independent medical practice professionals in physicians’ groups and independent

physicians to successfully implement patient-centered care to ensure quality patient

care and practice profitability. This literature review consists of peer-reviewed articles

that provide perspectives of various healthcare professionals concerning the

implementation of patient-centered care, quality of care, and entities that provide

patient support. This will be a thorough expositive literature review that involves

identifying, synthesizing, and encapsulating studies inside an extensive body of

research on the topic of patientcentered care (Paré et al., 2015). These are peer-

reviewed articles that provide current literature impacting patient-centered care.

The sources used to collect the literary review material were the Walden Online

University Library research database, which includes WebMD, Academic Search,

American College of Health Executives, ProQuest Central, EBSCOhost, Scient Direct,

and Government websites. The total number of sources for this literary review is 48

articles and one book. For the compilation of this study, 88% of the sources used had

publication dates less than 5 years old.

The Independent Doctor’s Practice Compared to Physician’s Groups

The independent doctor is a term used to refer to private physicians and their

practices (Woodcock & Crotty, 2015) and can be identified in several different forms,

such as individual practice, private practice, or concierge medicine. The independent

doctor can be a specialist in their field, such as optometrists, urologists, or oncologists;

there are many different specialists. The distinguishing factor is that they are solo

practices. In comparison, there are group practices such as physicians’ groups, medical

groups or hospital groups in which two or more physicians sign an agreement to share

rooms, equipment, staff, and patients (Dreher et al., 2019). This type of partnership can

have its advantages and disadvantages.

Some of the advantages are that it allows for better time management by

controlling the work hours, there are shared resources between the physicians, the

expenditures are split between the partners, and there are opportunities to standardize

processes (Dreher et al., 2019). Sharing the funds and investing in medical records

software helps the groups provide the organization with an administrative structure for

the staff. Some independent doctors offset their costs by sharing offices and some of their

staff. Colocation and maintaining their individual practice is one of the ways that

independent doctors are able to control their cost of doing business. Some additional

advantages of group practice, according to Lin et al. (2006), are that they provide a wider

range of medical services and professional consulting between other doctors within the

group to share opinions to provide service to their patients. This reduces the amount of

time the doctor would take researching a diagnosis and the response time with getting

back to the patient. Young physicians benefit by entering an already established practice

and there is an income difference between the physician’s group and the independent

physician in that the income is higher (Lin et al., 2006). There are opportunities for the

younger physician to have mentors to work next to and network with.

There are some disadvantages of the physician’s group, such as, in the physician’s

group, there is an organizational structure that determines processes and policies instead

of individual physicians making decisions and determining policies and procedures. In

the physician’s groups, interpersonal relationships and management of resources suffer

the larger the size of the organization (Zwiep et al., 2021). The larger the organization, the

more complex the paths of communications can become (Project Management Institute

[PMI], 2017). In an independent physician’s practice, the physician is the primary

decision-maker for the business and is directly impacted by the outcome.

Key Principles of Patient-Centered Care

The key principles of patient-centered care are “superb access to care; patient

engagement in care; clinical information systems that support high-quality care,

practicebased learning, and quality improvement; care coordination; integrated,

comprehensive care and smooth information transfer across a fixed or virtual team of

providers; ongoing, routine patient feedback to a practice; and publicly available

information on practices” (E. L. Davis et al., 2020). The patient-centered care framework

provided a useful lens to explore strategies to implement patient-centered care to improve

quality patient care and practice profitability because the patient-centered care framework

is useful for viewing each patient as a unique human being who requires care specifically

focused on the needs of each patient. I have chosen the patient-centered care framework

because of its focus on the patient and its promotion of their relationship and involvement

in the decision-making process with healthcare professionals. A partnership has been

established between healthcare providers, their patients, and the families of their patients.

This partnership ensures the patients’ wants, needs, and preferences are respected during

decision-making. It also ensures that education and support are given to patients and

caregivers so they can make decisions and participate in their care (Edgman-Levitan &

Schoenbaum, 2021). The concept of patient-centered care provided the groundwork for

building relationships between patients and healthcare professionals. Laws define

minimum standards, whereas accreditation standards describe optimal performance; laws

focus on the rights, whereas accreditation standards also point out ways in which

hospitals may act to deliver these rights (Edgman-Levitan & Schoenbaum, 2021). Global

laws and policies support the implementation of patient-centered care. However, quality

of care is an important consideration for patients. It does not matter to the patient what

providers think they have communicated or documented in the chart. If the patient does

not understand or remember it, the quality of care suffers (Edgman-Levitan &

Schoenbaum, 2021).

Concepts concerning patient-centered care principles were developed on behalf of

Picker Institute and The Commonwealth Fund by researchers from Harvard Medical

School, who used a variety of focus groups (discharged patients, family members, and

healthcare staff), along with a review of other pertinent literature to develop the principles

(Ortiz, 2021). These basic principles drive the implementation of patientcentered care and

provide the foundation on which to implement elements such as quality, communication,

or establishing relationships between patients, families, and healthcare professionals.

These foundational principles are respect for the patient’s values, preferences, and

expressed needs; involvement of family and friends; coordination and integration of care;

information, communication, and education; physical comfort; emotional support and

alleviation of fear and anxiety; transition and continuity; and access to care (Ortiz, 2021).

Nursing is an integral part of the relationship with the patients and their families because

they are front-facing and provide direct communication and interaction. Policies, such as

patient-centered care policies, must be guided by or grounded within unique nursing

knowledge, as found within nursing theories (Ortiz, 2021). These policies adopted by

hospitals and physician groups help manage patient experience and quality of care.

According to Tucker et al. (2023), patientcentered care is a fundamental approach to

healthcare where the needs are patientcentered, comprehensive, coordinated, accessible,

and dedicated to quality and safety.

Perspectives of Discourse Concerning Patient-Centeredness

The patient-centered care initiative is being implemented in many different

countries and is recognized by the World Health Organization (WHO; Siouta & Olsson,

2020). Though there are various of implementations, the concept of patient-centeredness

is unclear (Siouta & Olsson, 2020), According to Pluut (2016), there are three

perspectives of discourse concerning patient-centeredness: care for patients, empowering

patients, and being responsive.

Care for Patients. The patient is identified as a whole and vulnerable person who

needs help and the primary roles of the health professional are to provide care, reduce

suffering, and take responsibility for decision-making. The information provided to the

patient is given to promote compliance (Pluut, 2016).

Empowering Patients. The patient is identified as an autonomous decisionmaker,

and the healthcare professionals are to advise and coach the patient in the decision-

making process and facilitate this process for the patient. The information the healthcare

professional provides is given to the patients so they can make the best choices based on

their circumstances and values (Pluut, 2016).

Being Responsive. Healthcare professionals must be responsive to context, the

patient’s values, needs, and varying preferences, as there is no best way to carry out the

encounter with the patient. Health professionals must tailor the information, sometimes

for compliance and sometimes for choice, and sometimes they must withhold the

information. The decisions are made by the professionals and/or the patient depending on

the context and who the patient is (Pluut, 2016).

Framework for Patient-Centered Care

The framework for patient-centered care is a holistic approach to patient care that

prioritizes the patient’s values, needs, and preferences in their healthcare experience. It

involves the patient being active in the decisions concerning their health care and

fostering a collaborative relationship between the health provider and the patient. While

there are various theories about how the framework is implemented, there is a generally

recognized one known as the “4Ps,” which are the elements of the framework consisting

of the following:

Partnership. This element emphasizes the importance of establishing a

partnership between the patient and the healthcare provider in which both parties provide

feedback based on their expertise and knowledge.

Personalization. This element emphasizes that, in the context of patient-centered

care, each person is unique and requires personalized attention. Healthcare is tailored to

the needs, preferences, and circumstances of the patients.

Prevention. This element emphasizes the focus on a proactive approach to

healthcare about preventive measures and promoting healthy habits. Patient-centered care

encourages healthcare providers to promote disease prevention, healthy lifestyles, and

early detection of health issues.

Participation. This element emphasizes the importance of patient participation

and involving patients in their own care and treatment process. The healthcare provider

provides the patients with information about their condition, treatment options, and

potential risks and benefits. The purpose of these four elements is to promote a

collaborative and patient-focused approach to healthcare.

The Implementation of Patient-Centered Care

The implementation of patient-centered care varies depending on the business

environment it is being used in. The healthcare providers are required to have the tools

and processes to implement the patient-centered care policies and are responsible for

creating the plan of care for the patients (Papavasiliou et al., 2020). There are various

software tools that are available to that can assist with managing patient-centered care for

healthcare professionals. Patient-centered care is also impacted by environmental factors

such as population growth, geographic location, the composition of the financial classes

such as upper, lower, and middle classes and how the business attracts its patients for

healthcare delivery (Anabila, 2019). The physicians must adjust their businesses to meet

the needs of their communities. The location of the medical practice impacts how they are

funded and well as the type of patients that they see on a regular basis.

Establishing Healthcare Professional and Patient Relationships

Patient-centered care is a holistic approach to the patient and healthcare provider

relationship (Gallée et al., 2023). Communication and participation of the patient are

crucial in implementing patient-centered care, and pre-assessment tools are effective in

creating effective communication. Pre-visit assessment tools focus on involving the

patient and the physician through the patient care process, and it can occur at the end of

each visit, arranging for the next visit, programming for the next clinical and paraclinical

testing, gathering the necessary information for the subsequent visits, and take steps

regarding the handoff of patients (Gholamzadeh et al., 2021). A key component of

patient-centered care is preparing for each visit. There are conditions that change a

patient’s health that could impact their care, such as diet, medication, or a number of

other factors. It is essential that there be an open dialog that considers the existence of

crucial preconditions for patient-centered care in research and implantation (Hower et al.,

2020). Patients with comorbidities who have physician referrals are impacted by the

approach that physicians take for the patient’s treatment. Pre-consultation planning can be

employed before each patient’s consultation, between the patient’s visits, and during the

current visit to facilitate the complicated patient care procedure (Gholamzadeh et al.,

2021). Creating paths of communication through the pre-consulting process builds on the

relationship between the patient and the healthcare provider by staying up to date with the

most current condition of the patient.

Communication. Communication is the foundation of establishing relationships

in patient-centered care. A common factor affecting physicians’ relationships with their

clients was the limitation of time (Akseer et al., 2020). Nurses are the primary

customerfacing healthcare professionals who communicate information between the

patient and physician and rely on communication to build rapport with the patient and

construct the features and goals that meet patient-centered care requirements (Gilstrap,

2020). As physicians and clinic personnel schedule their appointments, only a certain

amount of time is allotted to each patient. Essential predictors in coordination and

integration are influenced by the involvement of family and friends (Bhoomadevi et al.,

2019). Implementing patient-centered care encourages the interaction of a patient’s

support network in the decision-making process and encourages the patient to make good

choices and behaviors that produce positive outcomes (Meier et al., 2019). The patients

have limited access to their physicians. This limitation impacts the relationship between

the physician and the patient, depending on the purpose of the visit. In the communication

healthcare approach (Zisman-Ilani et al., 2021), shared decision-making relies on

improving the patient’s clinical interaction pertaining to the medical decisions in chronic

conditions to improve the quality of care and positive outcomes. Interaction and

communication skills are the cornerstones of the physician-patient partnership while

making each meeting unique so that they can build an open relationship of trust and unite

with the one goal of patient-centeredness (Fridberg et al., 2022).

Patients are generally unaware of how much clinician time is available to address

their concerns when making an appointment. In contrast, the patient’s support network

has more access to them, and a rapport, such as trust, confidence, and shared

relationships, is already established. Similarly, the primary care clinician is often unaware

of what the patient expects to accomplish during the visit, leading to uncertainty about

how much time they can allot to each sequentially appearing concern and whether they

can reasonably expect to address necessary preventive services and chronic disease

management (Matulis & McCoy, 2020). Certain assumptions are made based on the

amount of time that is given and information gleaned from the patient. Neither patient nor

clinician expectations can be adequately managed through standardized scheduling

templates, which assign a fixed appointment length based on a single stated reason for the

visit (Matulis & McCoy, 2020). Communication in patient-centered care is crucial in

building trust between the patient and the healthcare team. It is vital to have effective

communication not only between the doctor and patient but also with the staff and

collaborating professionals to ensure that all coordinating entities meet the unique needs

of each patient (Abubakar et al., 2020). In a collaborative business environment, it is

crucial stakeholders communicate effectively and that communications complement the

relationship between the healthcare provider and the patient.

Communication between primary care physicians and other physicians in

specialized fields is equally important in providing quality care for patients. This type of

communication comes in the form of a formal referral letter from the general practitioner

requesting medical specialist assistance concerning a patient (Scaioli et al., 2020).

Medical specialists are vital in providing additional healthcare to patients because they

provide expertise in areas outside of the service provided by the primary physician. Once

the initial contact with the primary physician and the medical specialist has been made,

the physician will communicate via phone or email, and the specialist will have a direct

consultation with the patient (Scaioli et al., 2020). The patient-centered care process

continues with the medical specialist, and the patient will be informed and involved in the

decision-making process regarding their healthcare plan.

Empowerment. The goal of patient-centered care is to empower patients to have

a say in their decision-making to improve their health and management according to their

personal preferences, beliefs, and values (Heggdal et al., 2021). When a person is

empowered, they have a vested interest in the outcome, patent-centered care includes the

patient as part of the process of the outcome. There is a global recognition of the need for

patient-centered care. In a study conducted in China related to the concept of patient

empowerment, an ecological framework of communication in healthcare setting was used

to examine the social, clinical, and media factors that could empower patients (Jiang &

Street, 2018). The study reinforces the importance of communication between patients

and medical providers in building a stable relationship. Results from a survey of 401

Chinese adults (response rate 34%) showed that respondents felt more empowered as

healthcare consumers when they reported having more social capital bonding and

bridging and using the Internet for health purposes more often (Jiang & Street, 2018).

Providing multiple methods in which the patients can communicate with members of the

healthcare system gives the patients a sense of empowerment and involvement in their

care plan.

In the effort to promote shared decision-making, the patient and the healthcare

professional are encouraged to work together to make optimal healthcare decisions

(Beaudart et al., 2021). Patient-centered care relies on meaningful interaction between the

healthcare provider and the patient by sharing pertinent information that helps the patient

navigate through the decision-making process. In the decision-making process (Vogel et

al., 2023), the patient-centered care initiative facilitates collaboration, debate, and

responsibility between the participating patients, their family members, or appointed

guardians, and healthcare professionals.

Some of the hallmarks of effective communication are active listening, empathy,

the use of open-ended questions, and developing an understanding of the patient.

According to Beaudart et al. (2021), the healthcare professional can facilitate this process

with the use of decision aids to provide information on diseases, and the benefits and

risks of treatment. For the patient, this type of information can be empowering and help

them make the best choice available to them under their personal values, circumstances,

and beliefs. The challenge is that some patients are health illiterate and do not understand

some of the language used by the healthcare provider when they are providing some of

the information to (Beaudart et al., 2021). In cases like this, the healthcare professional

must navigate through the communication barrier by adjusting their communication style

to one the patient can better understand or identify a way to communicate with the patient

more effectively, for example, an interpreter of different types of communication media.

Support. The patient-centered care initiative strives to allow the patient and their

support structure to be involved with the decision-making process and have an active role

in their individual care plan. The physician-patient interaction and relationship are the

core elements of the healthcare system, which is developing towards greater patient

involvement in required medical decisions regarding the patient’s medical condition

(Lipovetski & Cojocaru, 2019). The relationship between physician and patient is crucial

in the patient-centered care approach, and it offers the opportunity to educate the patient

concerning concerns and conditions of their health care plan. Patient-centered care

represents a central approach aimed at improving health providers’ efficiencies,

encouraging patients to become partners to a certain extent with the design and delivery

of medical care (Lipovetski & Cojocaru, 2019). The communication aspect, along with

the education of patients, helps to develop a shared decision-making experience. The

focus on patient-centered care and shared decision-making among patients with chronic

conditions is the main interest in a patient-centered approach, increasing over the recent

decades in medicine and health sciences, focusing on patients’ individual and

understanding their personal needs and feelings (Lipovetski & Cojocaru, 2019).

Developing a relationship between healthcare professionals and their patients opens the

opportunity to set expectations and builds the bridge to defining quality of care.

Collaboration. Collaboration between multidisciplinary teams is crucial to the

treatment of patients and is a vital component of patient-centered care because it revolves

around effective communication. The complexity of multidisciplinary teams calls for a

multilevel approach where some variables are at the individual level while others are at

the team level (Zamorano et al., 2023). Various ways require multidisciplinary teams to

interact, such as referrals required to procedures outside of the primary doctor’s scope of

care or patients with co-morbidities. In the context of mental health care teams, lack of

confidence signals a passive role; it is also known that communicating pertinent

information helps establish credibility and trust (Durand & Fleury, 2021). This confidence

and trust are further compounded if the interacting disciplines do not know what the other

is doing. For example, for individuals with co-morbidities, the treating physicians need to

be aware of the medications the patients are on and if they have negative interactions if

taken together. Communication comprises two elements: first, collaboration is related to

the teams’ ability to respond to their challenges. Second, it is associated with individuals’

beliefs central to the delivery of interprofessional care (Durand & Fleury, 2021). In the

context of patient-centered care, the patient should be made aware of situations that come

up when there are multidisciplinary teams and should be involved in any decision-making

activities.

A collaborative challenge with patient-centered care and primary care physicians

is the concern with dealing with the needs of patients with comorbidities. Patients with

two or more co-existing chronic conditions are not very uncommon. For example,

patients with type 2 diabetes tend to have issues with high blood pressure. Current

primary care delivery is not optimally tailored to the needs of patients with

multimorbidity; patient-centered care has the potential to overcome this obstacle (S.

Kuipers et al., 2020). The condition of multimorbidity is defined as a person who has

been diagnosed with two or more chronic conditions (Wright & Brell, 2023). When a

patient has multiple chronic health conditions, they can have multiple physicians taking

care of the specific need they specialize in. The communication between those

professionals that are beyond the scope of the primary care physician is sometimes

inadequate (Smeets et al., 2020). Patients with comorbidities require additional

consideration because, in some cases, they are of lower income, in a higher age bracket,

are of lower education, and require specialized physicians. Patient-centered care often

requires that healthcare professionals spend more time and exert more effort during

consultations and in additional training sessions and workshops and that they collaborate

with professionals in other healthcare disciplines (S. J. Kuipers et al., 2021). In the case

of comorbidities, the patients depend on healthcare providers to provide them with clear

communication and accurate feedback so that they can clearly understand their

circumstances. A systematic review showed that fragmentation between primary and

secondary care poses a major challenge to the provision of care to patients with

multimorbidity (S. J. Kuipers et al., 2021). Multimorbidity or comorbidities are

multifaceted, and the healthcare professional must address a variety of the individual’s

needs (Poitras et al., 2018). Good communication and collaboration with the different

healthcare disciplines with and on behalf of the patient contribute to a positive outcome

and quality of care.

The Value of Quality of Care in the Patient-Centered Care Environment

Patient-centered care is meant to be patient-centric and, during the initial response

to COVID-19, offered the opportunity to present the ability to be flexible to change.

Quality of care is improved by educating healthcare professionals on best ways to care for

their patient’s families and communities (Kearney et al., 2020). The healthcare profession

is constantly improving to how they take care of patients. Patient-centered

care also improves by providing the patients with the most recent advances in treatments.

In the information-driven care era, although the goal of health systems is still improving

the quality of patient care, the patient care model has shifted from personal responsibility

to participatory medical decision-making (Gholamzadeh et al., 2021). Due to laws and

protocols put in place due to the pandemic, the approach to patient-centered care and the

cost of quality care required innovative approaches. pre-visit planning and visit

preparation concepts have been suggested by the American Medical Association as a

solution to address these challenges (Gholamzadeh et al., 2021). Quality of service is

always a factor in business. A practice that provides a high quality of service will attract

more patients and return customers with continuing demand for service (Singh & Prasher,

2017). The concept of patient-centered care relies on the physician having ample time to

interact with the patient and build a personal rapport with them. This can be challenging

because of the limited amount of time the physician has before seeing the next patient.

The COVID-19 pandemic provided many challenges for healthcare professionals

and how they interacted with patients. Adapting to those challenges and implementing

processes to take care of patients required innovative approaches. One of those

approaches is pre-visit planning. Implementing pre-visit tools within an advanced

planned care program might be more effective in moving towards effective

patientcentered care (Gholamzadeh et al., 2021). Pre-visit planning depends on well-

prepared questions and clear communication between healthcare professionals and

patients to provide a better quality of care in preparing for and during the medical visit.

Quality of care is pivotal in the implementation of patient-centered care. From the

patient’s perspective, the interaction between the healthcare professionals can have a

lasting impact on the outcome of the patient/physician relationship. Patient experience

data is emerging as an increasingly key component in assessing the quality of delivered

health services (Gendelman et al., 2021). Healthcare professionals need to understand

whether and how patient experience data can inform the design of service delivery from a

patient-centered perspective more pertinently than other indicators (Gualandi et al.,

2021). When considering patient-centered care, the patient’s expectations are important in

evaluating the quality of care. Gualandi et al.’s (2021) study emphasized that personalized

medicine should no longer only refer to targeted therapy. This requires management

teams to be able to customize the patient journey and identify different patient profiles,

which should not be reduced to the clinical pathway. There are numerous variables to

consider when evaluating the quality of care, and the patient’s perspective can provide

valuable feedback.

The quality of care for patient-centered care will change over time due to changes

in society. In a global sense, patient-centered care is defined by the societal needs of

where it is implemented, which can impact local laws and the way policies are

implemented. In a study about patient centering that covered the periods of the 1950s to

1960s and the 1970s to 1980s in Sweden (Siouta & Olsson, 2020), important political

decisions, for example, decisions regarding legislation and change in socially important

activities such as health care and education, can only be taken following an official

investigation. This impacted the perspective of patient-centered care because, during the

1950s and the 1960s in Sweden, the economy expanded, which meant that large financial

resources could be invested in health care. However, through the late 1970s and early

1980s, the economic conditions of the welfare state, and therefore also of the health care

system, started to deteriorate dramatically (Siouta & Olsson, 2020). From a political

perspective, the concepts of how to implement patient-centered care were impacted by

economic factors. By analyzing the historical evolution of patient-centered care, our

society can adopt a method of implementation to serve all patients equally.

Strategies Independent Medical Practice Professionals use to Implement

PatientCentered Care

The concept of collaborative care can be very supportive of patient-centered care.

Previous studies have established that pharmacists improve patient outcomes (Buatois et

al., 2022). Communication and interaction between primary care physicians and

pharmacists are vital in the context of patient-centered care. The pharmacist is a

specialized trade in the healthcare profession that focuses on the science of providing

public services directed at patients’ health and well-being to ensure the correct, effective,

and rational use of drugs (Ilardo & Speciale, 2020). There are various conditions that can

impact the absorption and effectiveness of different medications. The pharmacist’s scope

of practice includes promoting efficiency and improving patient’s access to care (Rough

et al., 2021). Patients in the pharmacist-led chronic disease state management clinic were

frequently given choices to think about their care, showing how their actions influence

their condition, helped to set specific goals, and experienced visits in which they felt their

values, beliefs, and traditions were considered before deciding on a particular treatment

plan (Buatois et al., 2022). Pharmacists have direct interaction with patients and can be

pivotal in encouraging them to take their medication as prescribed and answering any

questions the patient may have about their medication. According to Miranda et al.

(2019), pharmacists play a role in helping patients understand certain aspects of medical

insurance coverage. The support pharmacists provide to physicians in implementing

multiple strategies that improve patient medication use and contribute to support of

patient-centered care.

Referrals from primary physicians to other medical specialists are common

practice. Primary physicians and general practitioners make up the majority of referrals to

medical specialists (Wright & Brell, 2023). A referral is a communication from one

physician to another concerning a particular need for a patient that is outside the scope of

the general practitioner (Scaioli et al., 2020). The referral seeks expert advice and

guidance in treating the patient’s specific ailment. Some examples of medical specialists

are urologists, oncologists, and cardiologists. The patient is the focal point, and

collaboration between the primary care physician and the pharmacist can be leveraged to

provide positive outcomes to the patient (Ng et al., 2020). Though there are few

differences between the pharmacotherapy and usual care, groups indicate that patients are

satisfied with their care at the clinic and that the patient experience in this

interprofessional setting is well-perceived on both sides (Buatois et al., 2022). The

relationship between the physician and the pharmacist directly impacts how the patient

perceives the effectiveness of their healthcare plan.

Conceptual Framework

Carl Rogers was a pioneer in the humanistic psychology movement in the 1950s

and the innovator of patient centered care (Lewandowski et al., 2021). His approach

emphasized that the doctor be genuine with the patient, remain conscientious of the

patient’s emotional state, relate with the patient in a manner to shows empathy, and

project a positive demeanor of understanding(Joseph, 2020). The conceptual framework

for this study is patient-centered care, developed by Balint in 1969. Balint viewed each

patient as a unique human being who required care specifically focused on the needs of

each patient (Santana et al., 2017). Initially, doctors evaluated the localizable illness

through scientific examinations to identify faults in the physical body or in one of the

body systems. According to Santana et al. (2017), Balint’s approach was to treat

illnessoriented medicine and include a patient-oriented medicine approach. This

framework promotes the development of a more relationship-based approach to

healthcare.

Transition

In this section of the study, I conducted a literary review aimed at exploring

strategies for some independent medical practice professionals in physicians’ groups and

independent physicians to successfully implement patient-centered care to ensure quality

patient care and practice profitability. Section 3 will focus on the Study Research

Methodology, and Section 4 will present the Findings and Conclusions of this study.

Section 3: Research Project Methodology

Project Ethics

As the researcher, I was responsible for ensuring the study met the highest ethical

standards and the expected requirements of Walden University, along with the guidelines

set by the IRB (approval number 07-08-24-0070593). According to Ravitch (2020), the

qualitative researcher focused beyond rapport to authentic engagement; this required a

rational mindset and several specific methodological commitments and attendant

methods.

I had experience with this topic because I volunteered to work with elderly care

facilities and had conducted research involving patient-centered care. I was new to my

current geographical location and looked forward to meeting possible participants.

Through my personal experience with the healthcare system as a patient, I had some

understanding of my research area.

When conducting the pragmatic inquiry interviews, there were a few questions

that needed to be addressed regarding consent, such as whether it was necessary or

desirable to seek consent, from whom consent should be obtained, how consent should be

secured, from whom consent was being sought, and what counts as free consent

(Hammersley & Traianou, 2012). It was my duty to protect the interviewees’ anonymity.

For this study, the interviewees’ names were not used. All interviewees were informed of

the nature of the study, the benefits of the research, and the concerns or risks associated

with participating in this study. The interviewees were provided with a consent form to be

signed. An interviewee was allowed to revoke their consent at any time and discontinue

participation in the research. As a professional, I abided by the directions of the IRB to

ensure ethical requirements were met.

According to Hudson and Collins (2015), the IRB offers the researcher guidance

and assistance to ensure the study met the requirements to conduct a successful study.

According to Weissman et al. (2018), to adhere to IRB guidelines, the Patient-Centered

Outcomes Research must conduct meetings regularly with IRB chairpersons to examine

ethical and regulatory oversight issues and concerns. To adhere to the IRB guidelines, I

informed participants their information would be kept confidential, and they could have

requested to withdrawal from the study at any time without consequence. They could

have requested to withdraw by calling, texting, or emailing. To safeguard the security of

the participants’ information from theft, loss, or damage, I protected the gathered

information, both digital and documented, in a fireproof safe for 5 years, after which time

I will destroy all the stored information.

Nature of the Study

I chose the qualitative method for this research project. Researchers use

qualitative research to weigh the variables of feasibility, competency, ethics, and interest

(Marshall et al., 2021). This qualitative research included a personable interaction

between the researcher and participants who provided insight into an individual’s

decision-making process (Ravitch, 2020). Because I sought to understand individual

decision-making processes, the qualitative method was appropriate for my study. The

design I chose for this study was a pragmatic inquiry because it was appropriate for

researchers using case studies to explore a specific subject area within a specific

organization(s).

Population, Sampling, and Participants

Understanding the population of this study was vital in guiding the scope of the

study (Ravitch, 2020). The targeted population of this study was healthcare professionals

experienced in patient-centered care environments. It was critical to identify the study’s

goal and determine which size was adequate in identifying sample size. According to

Marshall et al. (2021), access to literature and concepts that guide sampling decisions,

smaller sampling was used to obtain newer knowledge about the subject and refine

existing theories. I used information that existed to frame and explain the existing state of

the business understanding of patient-centered care. In qualitative research sampling, the

goal was not to generalize; size was not as important as it was with quantitative research

(Ravitch, 2020); rather, it was the purpose of the study, whether it was useful, what was at

stake, and whether the information was credible. Yin (2018) suggested a small sample

size was adequate for case study design because the focus of a case study was on data

richness and not data quantity. Gerring (2007) noted that case studies often contained less

than 12 and often only one case. I interviewed six participants for this study.

I selected six healthcare business professionals with experience in patientcentered

care implementation who shared some of the financial challenges they had addressed

along with their successes and failures. I interviewed two medical professionals from

physician’s groups, three independent physicians’ practices, and one healthcare manager

about their business approach to patient-centered care. For this study, each participant

held a position in a healthcare organization that provided business services relating to

patient-centered care. The two physician’s groups were family practices that had direct

affiliations with local hospitals. The three independent physicians were one optometrist,

two were family practitioners, and one healthcare manager with no direct affiliation with

hospitals. All the participants were in the same suburban area location and provided

services for the same population.

According to Gill (2020), in qualitative research, the standard sampling methods

are listed as (a) convenience, (b) snowball, (c) purposive, and (d) theoretical. The method

used in qualitative research differs from that of quantitative research because the basis is

grounded in human experience (Sandelowski, 2004). The method used in the study can

change based on the data collected, the analysis and guided the outcome of the research.

The convenience sampling method involves volunteers participating in a research

study. It is easy to organize and manage, offers efficiency, and is economical for both the

researcher and the participant. However, some volunteer participants lack proficiency to

provide the depth of knowledge for the study.

The snowball sampling method, also called the chain method, relies on the initial

participants’ recommendation of other individuals interested in participation with the

study. The benefits of this methodology is practicality and cost-effectiveness, people are

appropriate for the study, and there is less time required to gain trust. The disadvantages

are that the quality of referrals may be problematic or limited.

The purposive sampling method is also called purposeful, judgmental, or selective

sampling. The researcher develops criteria for the type of participant, such as knowledge

of the content being researched. This sampling had the benefit of gaining participants

with specific knowledge and input into the study. The disadvantage was the challenge of

identifying and recruiting participants with intricate knowledge of the research subject

matter.

The theoretical sampling method was based on grounded theory, and the

researcher samples to generate the theory. This method benefited from being the basis of

grounded theory and clarified my understanding of the emerging theory. There do not

seem to be any detractors to this method as part of the grounded theory study.

For this study, I used selective sampling, a proponent of purposive sampling. The

target population included six healthcare management professionals with business

knowledge of implementing patient-centered care. Two were with a physician’s group,

three from individual physician practices, and one from a healthcare medical

professional. The selection of these participants provided the opportunity to have

different perspectives on the business ramifications of patient-centered care and how they

were approached in different environments. I used my professional network of healthcare

professionals and social network platforms such as Indeed, LinkedIn, and Facebook.

These platforms were tools that helped solicit and communicate information to identify

candidates that best met the study criteria.

For this study, I used pragmatic inquiry analysis to get the participants’ open and

candid viewpoints from their individual experiences (Fusch & Ness, 2015). Sampling

decisions related to the participants who were interviewed in the study (Ravitch, 2020).

Flick (2018) stated that the sampling process consisted of the selection of a site that meets

your study’s goals, identifies with situations that were specific to the study research,

selects specific topics that directly address the study, and identifies related topics that

have direct relevance to the study. According to Fusch and Ness (2015), there was no

one-size-fits-all; rather, there was rich and thick data. Fusch and Ness further defined the

differentiation between rich and thick data as rich data was high in quality and thick was

high in quantity. According to Ravitch (2020), data saturation is based on the research

questions and reaching the point where the responses end or there are sufficient data to

answer the research questions. The sampling of this study consisted of six healthcare

professionals who were versed in the implementation of patient-centered care.

Data Collection Activities

According to Ravitch (2020), instruments are tools to collect study data. I was the

primary data collection instrument and collected data using semi-structured interviews. I

conducted an extensive literary review that provided the background to build the

foundation of this study. I used an interview protocol (Appendix A) to promote

interaction with the participants and the study material using open-ended questions. The

interview questions comprised refined qualitative research questionnaires and interview

schedules (Marshall et al., 2021). The interview questions are listed in Appendix B. The

interview sessions were recorded using my Zoom audio recording software.

Data triangulation collected information from different sources (Bougie &

Sekaran, 2019). The different sources for this study were healthcare professionals with

specific knowledge concerning patient-centered care. I conducted virtual semi-structured

interviews using Zoom. I recorded the sessions and transcribed the audio sessions. Once I

completed my notes, I shared them with the participants and confirmed they agreed with

the recorded information. The process and protocols are in Appendix A. Reliability and

validity were enhanced by using triangulation to review the recording and text to ensure

accuracy and data analysis of the interview to confirm the study’s outcomes (Rooshenas

et al., 2019).

To prepare for this study, I solicited participants by sending out interview requests

via email and social media and handing out flyers. Once I received the applications back

from the participants, I confirmed the information and emailed them a copy of the

research study questions, the questions asked during the interview, and a consent form.

Once I received the acknowledged consent form, I worked with the participants and

scheduled an interview time that was convenient for them.

Data Collection Technique

Data collection was crucial to qualitative research, and I was the conduit that

bound the interviewee, the data, and the analysis together. The research question for this

study was: What strategies do some independent medical practice professionals use to

implement patient-centered care to improve quality patient care and practice profitability?

The researcher manages data collection and determines how the data are

compiled, according to Morgan and Nica (2020). The data collection technique for this

study was semi-structured interviews of business leaders and healthcare professionals

with experience in patient-centered care. The interview was conducted using the

interview protocol required by Walden University (see Appendix A). Data were

audiorecorded and used to transcribe for accuracy. The data were collected, compiled, and

analyzed for this study to explore strategies some independent medical practice

professionals used to implement patient-centered care to ensure quality patient care and

practice profitability. I conducted semistructured interviews with six professionals from

six independent medical practices in the St. Louis Metropolitan Statistical Area (MSA)

who implemented patient-centered care to improve the quality of patient care and practice

profitability. The interview was conducted using the interview protocol (see Appendix A)

and interview questions (see Appendix B).

In preparation of the research study, Shoozan and Mohamad (2024) suggested the

researcher prepare a questionnaire that consisted of the main questions pertaining to the

research, possible follow-up questions, and probing questions or an outline of related

subjects to discuss. In preparation for the interviews, I used the sample interview protocol

template provided in Appendix A. I observed the interviewees’ behavior and mannerisms

throughout the interview and documented those observations. I informed the participants

that the sessions were recorded prior to the interview. Once the interview was completed,

I reviewed the data to ensure accuracy and clarity.

Interview Questions

Initial Probe Questions

What are the special considerations your organization makes to effectively

implement Patient-Centered Care?

How does implementing the Patient-Centered Care initiative impact your

organization financially?

Targeted Interview Questions

How does implementing Patient-Centered Care have a direct impact on your daily

business?

How does implementing Patient-Centered Care affect your employee hiring

process?

How does implementing Patient-Centered Care influence the quality of care and

time spent with your patients?

Targeted Follow-Up Questions

What makes your organization’s implementation of a Patient-Centered Care plan

make it stand out from your competitors?

What are the special considerations you make to support your

organization's

Patient-Centered Care initiatives?

Wrap-Up Question

What are some of the positive outcomes you foresee with implementing

the

Patient-Centered Care mandates?

What do you consider to be challenging in implementing Patient-Centered Care

within your organization?

Data Organization and Analysis Techniques

Compiling

Anonymity implies that the method to identify an individual in a sample of

participants because the data resulting from reports were aggregated and not individually

contextualized or displayed (Ravitch, 2020). I was Collaborative Institutional Training

Initiative (CITI) certified, which was a requirement from Walden University to ensure the

researchers understand the confidentiality requirement. I implemented those standards to

maintain the anonymity of the participants of this study. Confidentiality related to an

individual’s privacy and information use (Ravitch, 2020).

To ensure anonymity, each participant was assigned a unique identifier that was

alpha-numeric and specific to this research study. The unique identifier was used for the

folder to maintain the participants’ data with their specific identifiers, such as file names

and labeling, that were easily identifiable. The participants were informed of all the

information they provided to the study and can review or remove portions of the

information they provided. I maintained a journal, and information was logged in under

the participant’s unique identifier. Any changes or alterations were logged in with the date

and time and confirmed with the participant. All the study interview data were maintained

on a separate SD card secured with a passcode, and each folder had its own passcode. All

data collected were password protected, including those analyzed with the NVivo

computing software. All information and contributions from the participants of this study

remained confidential and protected by labeling them with a unique identifier,

e.g., S,1, S2, S3, S4, S5. The raw data will be maintained and stored securely for 5 years

from the completion of this study to maintain the information’s confidentiality and adhere

to ethical research practices, then properly destroyed following Walden University’s

secure research guidelines.

Disassembling

For my research, I used NVivo computing software to analyze the data collected

from the interviews. The NVivo computer software program was a tool that assisted the

researcher with managing, analyzing, and visualizing qualitative data and documents

systematically and individually (Dhakal, 2022). For this study, this software was used to

analyze the interview and assisted with organizing the notes. The benefit of using NVivo

was the software executed its algorithms fast and accurately. However, the downside was

this type of software was expensive and requires training to use effectively (Attard Cortis

& Muir, 2021). I used the NVivo software to analyze the data for this study.

Reassembling

Within qualitative research, a conflation between category and theme category

was sorted out in like areas, whereas similarities were related (Marshall et al., 2021).

According to Guest et al. (2020), saturation occurs when the researcher reaches the point

where the new data coming in provide little to no information for the questions asked. I

used the saturation process to determine when I had enough data for this research.

Using triangulation, I analyzed the data to isolate distinguishing characteristics.

Triangulation collected data in several manners, including recorded interviews, written

notes during the interview, and the analysis of comparing the individuals interviewed; one

was more confident in the results if using different sources results in the same results

(Bougie & Sekaran, 2019). For this research study, I conducted a mixed methods

approach to triangulation using semi-structured interviews of the participants to conduct

this qualitative study. The mixed methods approach allowed data triangulation from

multiple perspectives (Shaw et al., 2020). Using methodological triangulation, I managed

complex themes and underlying issues the interviewees communicated (Kelly &

Cordeiro, 2020). Using mixed methods provided additional avenues for me to analyze the

data.

Interpreting

While reviewing the qualitative data, there are three steps: data reduction was the

selection, coding, and categorizing of data; data display was the method of presenting the

data; and data coding was how to decipher the data to develop and display the ideas as

well as developing some preliminary conclusions (Bougie & Sekaran, 2019). This

research study used the NVivo software to analyze data. In grounded theory research

(Ruppar et al., 2018), two cycles are used to analyze the data in NVivo software; the first

cycle will provide descriptive NVivo codes to each transcript and a set of field notes. In

the second set of coding, they set patterns of coding to sort initial codes to preliminary

sets of categories. I used NVivo to code and categorize information transcribed from the

interviewees’ responses and temporarily stored information collected during the

interviews.

Concluding

The primary focus of this study was to identify key elements that helped

healthcare professionals implement patient-centered care and impacted practice

profitability and quality of care. After data were reviewed, the interviews reflected the

differences between physicians’ group practices and independent physicians’ practices.

The study explored the professionals’ perspectives and challenges they encountered with

implementation of patient-centered care.

Reliability and Validity

Reliability

Dependability was challenging to separate from validity; however, in qualitative

research, dependability was the employment of overlapping methods and in-depth

methodological descriptions that allow the research to be replicated (Chowdhury, 2015).

During this study, I kept a detailed journal documenting how the study was conducted

and how the data was analyzed. According to Lincoln and Guba (1985), it was suggested

that processes be recorded in detail to allow future researchers to duplicate the work to

produce similar possible results.

According to Bougie and Sekaran (2019), qualitative data analysis has category

and interjudge reliability. I formulated categories that provided clear and concise

definitions of the categories that represented the responses and those that did not.

Judgments were made in a firm, fair, and consistent means and can be replicated to

produce a similar outcome. In qualitative research, reliability relies on consistency, where

a margin of variability was tolerated (Leung, 2015).

It was essential my conclusions be verified by ensuring that the conclusions were

plausible, reliable, and verifiable (Bougie & Sekaran, 2019). Reliability and validity

imply the competence of the research and whether it is trustworthy. Transferability,

dependability, credibility, and confirmability were four concepts that help the researcher

achieve reliability and validity (Lincoln & Guba, 1985). The researcher is responsible for

immersing themselves in the research, understanding and explaining the results, and

ensuring their conclusions are supported. I confirmed my reliability and validity with the

interviewees through data triangulation and confirmation.

Validity

According to Cypress (2017), in the context of qualitative research, validity

focused on the accuracy and truthfulness of a research study. Research validation was

challenging and complex in keeping true to the subject of the study. Validity was ensured

by the methodical triangulation of the interviews and examination of the quality

assurance records related to patient-centered care as well as by confirmation of the NVivo

data analysis software and the accuracy of the recorded data provided. According to

Morse et al. (2002), the researcher seeks out negative cases to ensure validity by

accentuating the contrasts to develop analysis that were less obvious. Using the analysis

of compare, I explored the differences in the business approaches between independent

physicians and physicians’ groups. Validity is the way researchers assert that their

findings were accurate to the life experiences conveyed by the study’s participants

(Ravitch, 2020).

Transferability

Purposive sampling enhances transferability and provides vivid descriptions and a

wide variety of detailed information which results in robust data collection (Cypress,

2017). In my study, purposive sampling was used. The transferability translated to content

and data received by all participants and helped synchronize them in the data analysis

process.

Credibility

It was crucial to establish credibility because it helped build the relationship with

the participants and motivated them to interact and respond freely without bias by

removing any fears, suspicions, anxieties, and concerns they had about the research and

its outcomes (Bougie & Sekaran, 2019). Building a good rapport with the participants

allowed them to relax and provide sincere responses. According to Cypress (2017),

credibility is the accurate and truthful depiction of an individual’s lived experience. For

this study, I established credibility by setting the criteria that the participants were

healthcare professionals with extensive knowledge of the business aspect of

patientcentered care implementation.

Conformability

Conformability implied meeting criteria, and Cypress (2017) suggested that this is

met by maintaining a journal during the research process. According to Connelly (2016),

conformity is established when others confirm and corroborate the results. Keeping notes

and doing daily introspection proved beneficial and pertinent insight to the study. I used

this process in review of my research for context and reference throughout the study.

Data Saturation

According to Fusch and Ness (2015), there is no one-size-fits-all; rather, there was

rich and thick data. Fusch and Ness further defined the differentiation between rich and

thick data as rich data is high in quality and thick and high in quantity. According to

Ravitch (2020), data saturation is based on the research questions and reaching the point

where the responses produced reoccurring themes and concepts in the data or there was

sufficient data to answer the research questions. The sampling of this study consisted of

six healthcare professionals who were versed in the implementation of patient-centered

care. I collected the data until there were no longer recurring themes and the consumption

was enough to replicate the study.

Transition and Summary

In this section of the study, I defined the Research Project Methodology, which

provided the elements required to ensure the study met the highest ethical standards and

Walden University’s expected requirements, along with the guidelines set by the IRB. In

Section 4, the Findings and Conclusions of this study will be presented.

Section 4: Findings and Conclusions

Introduction

The purpose of this qualitative pragmatic inquiry was to explore strategies some

independent medical practice professionals use to implement patient-centered care,

ensuring quality patient care and practice profitability. I conducted semistructured

interviews with six professionals from six medical practices in the St. Louis MSA who

implemented patient-centered care to improve the quality of patient care and practice

profitability.

I selected six healthcare business professionals with experience in patientcentered

care implementation who shared some of the financial challenges they addressed along

with their successes and failures. For this study, each participant held a position in a

healthcare organization that provides business services related to patient-centered care. Of

the healthcare professionals interviewed, two physician groups were from a urology

group with a direct affiliation to a hospital; the four independent healthcare professionals

interviewed included one optometrist, two independent family practitioners, and a

healthcare manager with no direct affiliation with hospitals. All participants were in the

same suburban metro location and were provided services for the same population. This

study used 1) semistructured interviews, 2) publicly available documentation, 3) artifacts,

and 4) testimonials to collect the data.

The participants in this study were referred to as P1, P2, P3, P4, P5, and P6. Table

1 summarizes the interview participants that contributed to this study.

Table 1

Study Participant Population Summary

Participant

Position

Patient care settings

Nurse practitioner

Physician's group

Physician

Physician's group

Nurse practitioner

Independent

physician

Nurse practitioner

Independent

physician

Owner/physician

Independent

physician

Healthcare manager

Independent

physician

Participant 1: This participant worked in healthcare for 12 years. The participant

achieved a Bachelor of Science in nursing and spent 5 years as a nurse in the ER. The

participant returned to get a Master of Science in nursing and worked both as a Nurse

Practitioner in the ER and urology offices. This participant worked for a hospital

physicians’ group. The participant stated their role required both financial and the

implementation and support of patient-centered care.

Participant 2: This participant was an MS, MD, and board-certified urologist with

over 20 years of experience. This participant worked for a hospital physician’s group

specializing in urologic oncology, male health and wellness, female incontinence, and

kidney stones. They were a member of the American Urology Association and provided

care to patients ages 18 and older. They directly influenced the financial and policy

impacts of the implementation of patient-centered care. This participant worked with a

hospital physician’s group.

Participant 3: This participant had over 33 years of healthcare experience, 13

years as an RN, and 20 years as a nurse practitioner. As nurse practitioners, they

specialized in women’s health and adult gerontology primary care and worked directly for

an independent physician. They had knowledge and influence in patient-centered care

financial requirements, policies, and implementation.

Participant 4: This participant was a nurse practitioner with 30 years of experience

as an RN and held various RN roles, including charge nurse and care manager, primarily

in acute medicine, care management, and nursing leadership. This participant’s current

role is for an independent physician’s group in private population health nursing

leadership. This participant also firmly understands patient-centered care and its

implementation and financial considerations.

Participant 5: This participant was an independent physician specialized in

optometry who owned their practice for over 25 years. They treated patients for their eye

care health needs and provided consultations. This participant directly influenced

financial decisions and policies required to implement patient-centered care in their

practice.

Participant 6: This participant had approximately 24 years of healthcare

experience. This participant started as a CNA and advanced to a Medical Assistant in the

healthcare profession. This participant worked in several areas of healthcare which

included: internal medicine, emergency medicine, OB/GYN, podiatry, endocrinology, and

dermatology. Their current role was the supervisor of policy and procedure, and quality

assurance. They had extensive knowledge of the financial aspect of the implementation of

patient-centered care.

Presentation of Findings

The overarching question guiding this study was: What are strategies some

independent medical practice professionals use to implement patient-centered care,

ensuring quality patient care and practice profitability? According to Santana et al.

(2017), Balint’s approach was to treat illness-oriented medicine and consider the

inclusion of a patient-oriented medicine approach. This framework promoted the

development of a more relationship-based approach to healthcare. The goal of

patientcentered care was the involvement of the patient and their family members in the

decision-making process. As stated by Ortiz (2019), congruence is vital because health

policy decision-making is guided by the beliefs and values about humans and health;

nursing knowledge should contribute significantly to the standards of practice that are set

forth in policies. It mandates that all physicians adhere to the patient-centered care

requirements.

To ensure anonymity, each participant was assigned a unique identifier that was

alpha-numeric and specific to this research study. The unique identifier was used for the

folder to maintain the participants’ data with their specific identifiers, such as file names

and labeling, that were easily identifiable. The participants were informed of all the

information they provided to the study. They were allowed to review or remove portions

of the information they provided. I maintained a journal was maintained, and information

was logged in under the participant’s unique identifier. Any changes or alterations were

logged in with the date and time and confirmed with the participant. All the study

interview data were maintained on a separate SD card secured with a passcode, and each

folder had its own passcode. Zoom was used to schedule, record, and conduct interviews.

Microsoft Word was used to transcribe the interviews, and NVIVO analytic software was

used to code and organize the data. The NVIVO computer software program was the tool

that assisted the researcher with managing, analyzing, and visualizing qualitative data and

documents systematically and individually (Dhakal, 2022). For this study, NVIVO

software was used to analyze the interviews, code the information to identify trends and

themes and assisted with organizing the notes.

Sixty-four subthemes were identified during the coding of the data. Further

analysis of the coded data extrapolated four key themes: 1) patient communication, 2)

financial consciousness, 3) quality patient care, and 4) time management. Figure 1

provides a representation of the identified themes.

Figure 1

Chart Representation of Key Themes

Theme 1: Patient Communication

Communication with the patients was a vital skill that physicians and their staff

needed to have to effectively build trust with their patients. For the exploration of

strategies to implement patient-centered care, to improve quality patient care, and

practice profitability, the patient-centered care framework is useful to view each patient as

a unique human being who required care specifically focused on their needs.

Patientcentered care represents a central approach aimed at improving health providers’

efficiencies, encouraging patients to become partners to a certain extent with the design

and delivery of medical care (Lipovetski & Cojocaru, 2019). Physician communication to

the patient required the consideration of many aspects.

Key Themes

Patient Communication

Financial Consciousness

Patient Quality

Time Management

P1 shared that their organization provided specific services to multilingual clients

by providing foreign language interpreters. They also provided sign language interpreters.

P1 stated that “We tried to call patients with results in a timely manner because we knew

with technology, many patients received their results at home so they saw them before us,

and a bad result created anxiety for patients”.

P2 said their organization implemented a program that involved patient

navigators. This was primarily in the oncology field for cancer patients because, in many

cases, when the patient was diagnosed with cancer, there were multiple physicians

involved in their care. Patients became overwhelmed in the management of appointment

scheduling with multiple physicians, multiple test scheduling, understanding the results of

these tests, monitoring their condition, and follow-up appointments with multiple

physicians. The initiative of the patient navigator deployment was to help the patient

navigate the complexities of their situation. P2 stated that this helped foster a

patientcentric environment so that the patient felt like they were involved in their care.

Previously, there was not a patient-centered model in place. The physician prescribed

something to the patient, and they would do it. The challenge was many patients had a

lower education level and were unfamiliar with many healthcare terms. The medical staff

were taught that when they were explaining a disease process or a health issue to a

patient, they should include the patient in the shared decision-making process because

they obviously cannot decide on something unless they are fully informed. As tools to

inform patients, a series of educational videos revolved around the basic concepts behind

individual surgeries. These were helpful in terms of making informed decisions and

preparing the patient.

P3 stated if they recognized that a patient needed more education and more

understanding, they would send a task through their one-point-of-access team. That team

then assigned a task to our care management, which sent nurses and social workers to

reach out to the patient where they were located, whether in a hospital or a home. This

outreach program was dedicated to spending extra time and educating the patient and

their support network about their medical needs.

Another observation presented by P4 was their practice contracted a company that

provides interpreter services for patients, and they also had a remote monitoring

partnership. The remote monitoring services were for chronic disease patients to maintain

frequent contact with the patient. Another partnership they had was that care management

staff go into the different hospitals and the patients' homes to ensure that patients were

getting what they regarded as personal needs and equipment. They also contracted out

wound care supplies and treatment, memory care, and home solutions for patients who

had any vascular, Alzheimer’s, dementia, or cognitive diseases.

During the interviews, the participants provided their experiences specific to their

communication with their patients. P6 shared the insight that patients understood more

when you spoke to them at a level they understood. To help patients unfamiliar with

healthcare, the medical staff tried to reword the terms more conducive to the patient’s

understanding. This same sentiment applied to the patient’s support structure. P6 also

added that whether it was the patient, their family, or acquaintances, a concerted effort

was made to ensure they were involved in everything that was done on behalf of the

patient. Any information the staff gives, their family or acquaintances were there with the

patient when they met, and many times, they were on the phone when the physician’s

team called to see how the patient was doing. If the patient forgot something, their family

or acquaintances let us know what was going on. P6 explained that there was not a direct

financial influence. However, it had an indirect influence due to the time consumed. P6

expressed that for them, the most challenging thing was getting used to the hands-on with

the patient and getting used to them having a voice when it came to their healthcare

decisions. In the past, the patient did not have a voice; they were just told what the

physician’s actions would be. The physician did not have to explain in a way the patient

understood what action the physician was taking and why and what reaction the patient

could expect as a result.

Communication is critical for relationship building between physicians and

patients. It establishes rapport and trust in providing patients with information to make

credible decisions concerning their medical plan. Nurses are the primary customer-facing

healthcare professionals communicating information between patients and physicians. At

the same time, relying on communication to build rapport with patients and construct the

features and goals to meet patient-centered care requirements (Gilstrap, 2020). Enhancing

communication, such as using a translator or interpreter so the patients can communicate

in their primary language with members of the healthcare system. This gives patients a

sense of empowerment and involvement in their care plan. Some factors impacting the

patient's communication level are their financial circumstances, education levels, and

support systems, such as family and friends. Implementing patient-centered care

encourages the interaction of a patient’s support network in decision-making. It

encourages the patient to make good choices and behaviors that produce positive

outcomes (Meier et al., 2019). The physician’s effort to understand their patient bridges

the communication barriers and enhances patient-centered care.

The patient-centered care framework promotes the development of a more

relationship-based approach to healthcare. The decisions made by healthcare

professionals and patients depend on the context and the patient (Pluut, 2016).

Patientcentered care encourages healthcare professionals to educate patients while

increasing their healthcare knowledge. This, in turn, allows patients more autonomy in

making informed decisions about their care. In the communication healthcare approach

(ZismanIlani et al., 2021), shared decision-making relies on improving the patient’s

clinical interaction pertaining to the medical decisions in chronic medical conditions to

improve the quality of care and positive outcomes. While providers are having these

interactions with their patients, it comes at a cost.

Theme 2: Financial Consciousness

Financial consciousness provided a backdrop for how physicians perceived

overcoming what was considered a financial challenge. According to Lin et al. (2006),

physicians provide a wide range of medical services and professional consulting with

other doctors within the group to share opinions and provide service to their patients. The

physicians interviewed expressed a financial concern in the context of what was

patientrelated and what was business-related.

Patient-Related

P1 provided the perspective that they tried to look out for patients, what's best for

them, and what was financially suitable for them. For example, with some diagnoses, two

separate procedures were required, and the organization would normally schedule two

separate appointments. Due to the patient’s financial circumstances, P1 would schedule

them to be conducted in one appointment. From P1’s perspective, the big corporations,

healthcare companies, and insurance companies do not need the money. The patients

were the ones impacted from a financial standpoint. P1 advocated doing things more cost-

effectively for the patient, saving money and time.

According to P2, the medical system revolved around money, and corporations,

healthcare companies, and insurance companies were in it to make a profit. The patients

were in the middle and suffered from a financial standpoint. P2 preferred to advocate for

the patient by providing more cost-effective options and preventing the patient from

experiencing an increased financial burden.

Business Related

From the organization’s perspective, P2 worked for many patient-centric concepts

that were not part of the revenue-generating stream. So, programs like the patient

navigator were putting money towards something that had no financial return and worked

against you.

P3 identified billions of dollars were spent on wound care, which negatively

impacted the practice’s revenue. Wounds resulted from other chronic conditions. Since

wounds were a consequence, they effectively managed them by treating, monitoring, and

using quality materials. The use of inferior wound supplies resulted in longer healing

times. Longer healing time equated to higher cost.

P4 touted how their practice contracted interpreter services to make sure the

patient understood what was being diagnosed and how they were being treated and

answered any concerns they may have. This was an outside expense that impacted on

their practice’s revenue because it was an extra cost.

In the case of P5, he stated that his staff went above and beyond to help patients

understand their insurance benefits and utilize them most effectively and efficiently. If

there was a problem with someone’s insurance, P5’s staff assisted the patient in getting

answers and found the resources necessary to help the patient.

P6 says they want to make sure that the patients were cared for in a way that they

were comfortable considering their financial situation. They want to make sure that their

patients were taken care of across the board when it came to anything that affected their

and affect their health, whether it was their housing, financial situations, food, or

medications.

Financial consciousness is an essential concern for business operations and the

patient’s financial status. During the interviews, the interviewees distinguished between

the two and explained their different approaches toward managing them. During the

literary review, the business addressed ways physicians’ groups managed costs by sharing

expenses. Independent physicians control the cost of doing business within their practice.

The medical insurance companies dictating what and how much they cover is a bridging

factor that impacts the patient and the physician. All of this adds another layer to the

financial consciousness of the business. Time is taken to coordinate efforts between

departments, insurance companies, and patients. This increases the cost to the healthcare

providers. According to Miranda et al. (2019), pharmacists play a role in helping patients

understand certain aspects of medical insurance coverage. Collaboration between

healthcare providers, billing, pharmacy, and other departments helps all providers to aid

in financial consciousness for patients. One challenge the interviewees communicated

was how to help the patients financially reduce their medical costs. Insurance companies

directly influence the cost and acceptance of different medications and procedures.

The contextual framework of patient-centered care addressing the financial

consciousness of both the business and patients came out during some of the interviews.

Some interviewees expressed concern about how the patients would be able to afford

treatment or medication. This concern is recognized by the relationship established with

the patient so an understanding of their individual circumstances can be considered.

Environmental factors like population growth, geographic location, composition of

financial classes, and how the business attracts its patients impact patient-centered care

(Anabila, 2019). Healthcare providers not only consider the type of insurance coverage a

patient has but also their educational level, economic situation, religious beliefs, and

access to other resources when developing the plan of care. As all of these factors can

impact the decisions made when considering the financial consciousness of the patient.

Theme 3: Quality Patient Care

Quality was a crucial part of patient-centered care; healthcare was constantly

challenged and measured based on quality of care. According to Tucker et al. (2023),

patient-centered care is a fundamental approach to healthcare where the needs are

patientcentered, comprehensive, coordinated, accessible, and dedicated to quality and

safety. Quality patient care was an overlapping theme shared with many participants. P1

said that sometimes they ran a little long with their patients because they tried very hard

to comfort them, create trust, and answer all their questions.

P2 promoted that the patient navigating system was a big step in the right

direction and was the difference between an integrated physician and a private practice

physician. P2 relied aggressively on the implementation of patient navigators or

advocates so they assisted patients in basically keeping their schedule, staying on track,

and making sure that they followed up with their appointments, testing, and surveillance.

P2 advocated, if you provided an exceptionally good service to a patient and they were

very satisfied with you, they might tell 1 or 2 people, but if you forgot to call them or you

forgot to give them a test result or they, unfortunately, had a bad outcome from surgery or

a complication, that individual was going to put forth a tremendous amount of effort to

make that known, whether that was on Google reviews or word of mouth to their friends

at church or work, because that was just kind of human nature. P2 had a couple of nurse

practitioners who basically functioned as low-level physicians. They were quite

competent and accomplished. They were offered for multiple reasons: to handle

straightforward issues when the patient does not necessarily need to see a physician, and

it was more expensive for the patient to a physician than it was for them to see the

nursepractitioner.

P3 said while they implemented the wound program, one of the issues was they

were using cheaper materials to clean and patch the patient’s wounds. To mitigate this

issue, P3 partnered with insurance companies to procure better-quality materials, which

resulted in better recovery and healing for the patient. P3 reported that their practice

implemented chronic disease programs where patients can be enrolled in COPD, diabetes,

asthma, heart failure, and dementia management programs. Each of these programs were

very specific to what a patient needs. Once a patient was enrolled in that program, we had

remote patient monitoring for the programs. They were contacted a couple of times a

week, and they entered their blood sugars and vital signs. These programs were very

specific to the disease processes and made an extra effort to provide quality and safety for

the patient.

P4 explained the provider and patient relationship was the center. We use

wraparound services to make sure the patient got what they need, to make sure that they

have complete and full care that was within their values and what they need for their

disease process to maintain health. The practice contracted with Care Convene, which

was an ADT service, so the practice got notified when their patients were in the hospital

or the emergency room and how long they had been there. P4 stated it was difficult since

they were outside the hospital system, because even though they had a good relationship

with the hospitals, they were outside of the physician's group and had no access to the

hospital’s records system. Having Care Convene allowed their practice to bridge that

barrier.

The theme of quality patient care was covered during the literary review guided

by the key principles of patient-centered care (E. L. Davis et al., 2020). The interviewees

referenced how quality was a significant factor while implementing patient-centered care.

Quality patient care begins with building a rapport with patients and is then extended as

trust, collaboration, cooperation, and coordination of care become a repeated pattern.

Quality of care is improved by educating healthcare professionals on the best ways to

care for their patients, families, and communities (Kearney et al., 2020). Interviewees

mentioned the use of evidence-based practice in improving quality care. Managing the

practice

Policies established by hospitals and physician groups help manage the patient

experience and quality of care. In the information-driven care era, although the health

systems' goal is still improving patient care quality, the patient care model has shifted

from personal responsibility to participatory medical decision-making (Gholamzadeh et

al., 2021). The contextual framework of patient-centered care predominantly revolves

around the patient and attention to their needs. Quality of care is always essential and

must be included while focusing on the patient’s needs. Interviewees identified several

ways this was accomplished. Using an interpreter helps accomplish a better quality of

care because the patient can understand. Identifying what the insurance company will

cover impacts the quality of care because we found a treatment or medication the patient

could afford. A healthcare provider can give state-of-the-art medical advice, but if the

patients cannot afford to take the advice, the healthcare provider will be ineffective, and

the patient will remain ill.

Theme 4: Time Management

A practice that provides a high-quality service will attract more patients and return

customers with continuing demand for service (Singh & Prasher, 2017). Patientcentered

care relies on the physician having ample time to interact with the patient and build a

personal rapport with them. This can be challenging because of the physician's limited

time before seeing the next patient. P1 said they scheduled a new patient appointment,

which was listed at 20 minutes, and an existing patient appointment was supposed to be

10 minutes; however, since she focused on the patient and getting their questions and

needs answered, she tended to go over that estimated time.

P2 stated that, on average, the appointment was scheduled for a 20-to-40-minute

timeframe to provide the patient with the diagnosis, help them overcome the shock,

educate them, and help them make an informed decision. P3 responded that as a clinician,

you get 15 to 20 minutes every time you visit a patient, and you try to educate the patient,

address medication needs, and conduct medication reconciliation. But you had to use

your clinical judgment.

The literary review compares the advantages of independent and group practices,

maintaining that time is essential to patient interaction. Some advantages of group

practice are the allowance for better time management by controlling the work hours, the

shared resources between physicians, split expenditures between the partners, and the

opportunity to standardize processes (Dreher et al., 2019). Independent physicians do not

have that luxury; however, they have the latitude to focus their financial decisions on

business elements that can elevate the value of their medical practice. A common factor

affecting physicians’ relationships with their clients was the limitation of time (Akseer et

al., 2020). The group physician interviewees expressed that time is a constraint limiting

their interaction with patients because scheduling only allows them fifteen to twenty

minutes per patient. In the case of independent physicians, they expressed that they have

a little more latitude because they have more control over their schedules. Similarly, the

primary care clinician is often unaware of what the patient expects to be accomplished

during the visit, leading to uncertainty about how much time they can allot (Matulis &

McCoy, 2020). Regardless of the practice type, time management is a major factor in

implementing patient-centered care.

In the contextual framework of patient-centered care, time is valued by both the

physician and the patient as a means of building a trusting relationship. Patient-centered

care often requires that healthcare professionals spend more time and exert more effort

during consultations (S. J. Kuipers et al., 2021). Some interviewees expressed that they

sometimes went beyond the allotted time to answer patient questions or provide for the

patient’s needs. The communication of pertinent information helps establish credibility

and trust (Durand & Fleury, 2021). The patient-centered care concept relies on the

physician having ample time to interact with patients and build a personal rapport.

However, this can be challenging because the physician has a limited amount of time

before seeing the next patient.

Business Contributions and Recommendations for Professional Practice

The specific business problem was that some independent medical practice

professionals lacked strategies for implementing patient-centered care, which can

improve quality patient care and practice profitability. However, this qualitative

pragmatic inquiry aimed to explore strategies they can use to implement patient-centered

care, ensuring quality patient care and practice profitability. The findings presented within

this research project can be applied by independent physician practice professionals to

implement patient-centered care, ensuring quality patient care and practice profitability.

The key themes identified in this project provided insight into how healthcare

professionals address specific issues. The theme of patient communication established

that communication was essential between the healthcare professional and the patient.

Interaction and communication skills were the cornerstones of the physician-patient

partnership while making each meeting unique so that they can build an open relationship

of trust and unite with the one goal of patient-centeredness (Fridberg et al., 2022). The

participants and their businesses had a shared emphasis and understood that there was gap

in patients' knowledge of medical terms and effective communication, which prompted

some businesses to invest in contracting interpreters and other patient-centric services.

Financial consciousness encompassed balancing patient care with the patient's

financial concerns and advocating for cost-effective solutions while navigating through

organizational constraints. Patient-centered care was also impacted by environmental

factors such as population growth, geographic location, the composition of the financial

classes, such as upper, lower, and middle classes, and how the business attracts its

patients for healthcare delivery (Anabila, 2019). When analyzing financial consciousness,

the participants expressed patients’ financial circumstances and addressed them on a case-

by-case basis. The participants also addressed the issue of their businesses or

organizations incurred costs by providing additional services necessary for exceptional

patient care.

Quality patient care is at the forefront of patient-centered care priorities. Patient

experience data are emerging as an increasingly key component in assessing the quality

of delivered health services (Gendelman et al., 2021). Some participants mentioned how

their businesses or organizations implemented specialized programs and partnerships to

enhance patient knowledge, service, outcomes, and satisfaction. Many of these programs

and partnerships were non-revenue-generating but beneficial to providing high-quality

patient care.

Time management is crucial in the healthcare environment. A common factor

affecting physicians’ relationships with their clients is the limitation of time (Akseer et

al., 2020). The participants conveyed that they sometimes exceed the scheduled

appointment times because they tried to ensure they provided patients with thorough

interaction while juggling the challenges of providing quality care within time

constraints.

This information may be valuable to all healthcare professionals, especially at the

business level, where it may help implement policies. The specific recommendation is for

independent physician practice professionals to implement patient-centered care, ensuring

quality patient care and practice profitability, implement best practices, build

communication with their patients, be financially conscious of the patient’s

circumstances and cost of doing business, constantly improve their quality of care, and

employ good time management scheduling. Healthcare professionals who influence

business and policy decisions would also find this valuable. This information should be

disseminated through lectures, articles, or training.

Implications for Social Change

The implications for positive social change may include showcasing alternative

practices beneficial to implementing patient-centered care. Healthcare providers are

required to have the tools and processes to implement patient-centered care policies and

are responsible for creating a plan of care for the patients (Papavasiliou et al., 2020). The

findings of this qualitative pragmatic inquiry provide independent medical practice

professionals with strategies for implementing patient-centered care, which can improve

the quality of patient care and practice profitability by sharing the experiences of

independent medical practice professionals. It addressed methods to improve patient

communications, alternative methods of financial mitigation, improving quality patient

care and time management, and adopting strategies to enhance quality patient-centered

care and practice profitability, contributing to social change. Implementing these best

practices will build better relationships between the doctors and their patients, improve

the quality of life through better communication with the patient and their support

network, and recognize patient financial circumstances to provide reduced healthcare

costs throughout the community.

Recommendations for Further Research

The parameters of this research were limited to six participants: two were

professionals from a physician’s group and four from independent physician practices.

The recommendations for future research would be to expand the research to include a

larger number of participants representing a larger population of patients. This project

focused on the Midwest suburban metro population. A larger major metropolitan area,

such as New York City or Washington DC, would provide more diversity and a more

comprehensive range of scenarios. Also, adjacent support or impacting activities such as

pharmacies, dental care, and network support entities should be included. These

recommendations would help provide a more expansive and comparative perspective of

the problem.

Conclusion

The purpose of this qualitative pragmatic inquiry was to explore strategies some

independent medical practice professionals use to implement patient-centered care,

ensuring quality patient care and practice profitability. The conceptual framework for this

study was patient-centered care, developed by Balint in 1969. Balint viewed each patient

as a unique human being who required care specifically focused on the needs of each

patient (Santana et al., 2017). Four key themes emerged from the data collection: patient

communication, financial consciousness, quality patient care, and time management. A

practice that provides a high-quality service will attract more patients and return

customers with continuing demand for service (Singh & Prasher, 2017). Consideration of

implementing some of the recommendations from this project can improve a practice’s

patient-centered care, ensuring quality patient care and practice profitability.

Business Problem Focus and Project Purpose

The specific business problem was some independent medical practice

professionals lack strategies for implementing patient-centered care, which can improve

quality patient care and practice profitability. Therefore, the purpose of this qualitative

pragmatic inquiry was to explore strategies some independent medical practice

professionals used to implement patient-centered care, ensuring quality patient care and

practice profitability.

The targeted population consisted of independent healthcare professionals

experienced in patient-centered care environments who had implemented successful

strategies that sustained their operations beyond 3 years. I used purposive sampling to

select at least six participants and gained access to them through professional associations

and social networks. To collect the data, I used semistructured interviews, publicly

available documentation, artifacts, and testimonials. The conceptual framework for this

study was patient-centered care, developed by Balint (1969) in 1969.

Research Question

What strategies do some independent medical practice professionals use to implement

patient-centered care to improve quality patient care and practice profitability?

Assumptions and Limitations

Assumptions

An assumption is an understanding of an individual based on their perspective

(Ravitch, 2020). There were several assumptions that were made about this study while

exploring the implementation of patient-centered care. First, the respondents were

knowledgeable and experienced in implementing patient-centered care. Another was that

the respondents had some direct interaction with the patients. Finally, I also assumed the

respondents’ understanding of the financial impact that implementing patient-centered

care has on their practice.

Limitations

A limitation creates constraints to scale to a manageable size (Ravitch, 2020).

This research study had three main limitations. First, this study was limited by the

location and patient population due to the suburban metro areas it was conducted. The

study was conducted in a higher populated area poses different challenges and

considerations. Second, the entities in this study were physician’s groups, medical

professionals, and independent physicians in general practice in suburban metro areas.

Unfortunately, the sample size was not large enough to compare the three entities.

Transition

In this section, I reviewed the purpose of this qualitative pragmatic inquiry, which

was to explore strategies some independent medical practice professionals used to

implement patient-centered care, ensuring quality patient care and practice profitability.

In Section 2, the study examines peer-reviewed articles that provided perspectives of

various healthcare professionals concerning the implementation of patient-centered care,

quality of care, and entities that provided patient support. In Section 3, the study focuses

on the Study Research Methodology, and Section 4 presents the Findings and

Conclusions of this study.