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Background Patient-centered care reflecting patient preferences and needs is integral to high-quality care. Individualized care is important for psychosocially complex or high-risk patients with multiple chronic conditions (i.e., multimorbidity), given greater potential risks of interventions and reduced benefits. These patients are increasingly prevalent in primary care. Few studies have examined provision of patient-centered care from the clinician perspective, particularly from primary care physicians serving in integrated, patient-centered medical home settings within the US Veterans Health Administration. Objective We sought to clarify facilitators and barriers perceived by primary care physicians in the Veterans Health Administration to delivering patient-centered care for high-risk or complex patients with multimorbidity. Design We conducted semi-structured telephone interviews from April to July 2020 among physicians across 20 clinical sites. Findings were analyzed with deductive content analysis based on conceptual models of patient-centeredness and hierarchical factors affecting care delivery. Participants Of 23 physicians interviewed, most were female ( n = 14/23, 61%), serving in hospital-affiliated outpatient clinics ( n = 14/23, 61%). Participants had a mean of 21 (SD = 11.3) years of experience. Key Results Facilitators included the following: effective physician-patient communication to individualize care, prioritize among multiple needs, and elicit goals to improve patient engagement; access to care, enabled by interdisciplinary teams, and dictating personalized care planning; effortful but worthwhile care coordination and continuity; meeting complex needs through effective teamwork; and integrating medical and non-medical care aspects in recognition of patients’ psychosocial contexts. Barriers included the following: intra- and interpersonal (e.g., perceived patient reluctance to engage in care); organizational (e.g., limited encounter time); and community or policy impediments (e.g., state decisional capacity laws) to patient-centered care. Conclusions Physicians perceived individual physician-patient interactions were the greatest facilitators or barriers to patient-centered care. Efforts to increase primary care patient-centeredness for complex or high-risk patients with multimorbidity could focus on targeting physician-patient communication and reducing interpersonal conflict.

Background Prior efforts to understand faculty culture have largely described monoliths where individuals are differentiated by their productivity. Little prior work provides rich faculty subcultural descriptions and their connections to specific activities, including disposition to change. Purpose/Hypothesis This article describes the goals, assumptions, methods, and inferences made about faculty culture within an engineering department at a large university with very high research activity, with the potential to enrich future discussions about change among the target audience of engineering faculty, administrators, and researchers. Design/Method We employ cultural consensus theory (CCT) to characterize faculty culture, based upon a detailed survey, analysis, and member checking. We use the academic ratchet—as a theoretical framework to interpret CCT results, and extend our understanding using previously published change theories. Results We discovered two faculty subcultures of roughly equal membership: (a) change‐oriented and (b) continuity‐embracing. Members of each subculture agree on the primacy of research but differ in their views of change, leadership, and trust. Members of the change‐oriented subculture seek large‐scale changes but feel disempowered to pursue them, while members of the continuity‐embracing subculture seek modest changes and feel empowered to enact them. Conclusions We introduce a scalable, person‐centered culture characterization approach (CCT) to the engineering education research community. This approach deepens our understanding of faculty culture, and our results reinforce the central role of the academic ratchet in shaping faculty activities. This analysis illustrates the potential roles of each subculture in enacting change of various types and magnitudes.