Table 4 Exemplar quotes by collaborative chronic care model element and extent of implementation

 Work role redesign

● “We have very experienced competent people on our team who know how [team-based care] should be delivered. This was a golden opportunity to start doing some of the things we accumulatively knew needed to happen” (Psychologist Time 2)

● “What this project did was address longstanding problems and issues that we’ve had in the clinic that have gone unaddressed…the CCM forced us to address some issues … like how to make referrals, what our discharge criteria are, when to refer to specialty programs… just a lot of very subjective things that we have made more objective and made processes more efficient” (Psychologist Time 2)

 Patient self-management

● “We actually have the patient join our team meetings which we’ve never done here before. We sat down with the patient and discussed [treatment] options so that the patient knew everybody on the team and so we are all on the same page” (Nurse Time 2)

● “Yes, the BHIP team provides evidenced-based treatments and there are some additional evidenced-based therapies that are being introduced” (Psychiatrist Time 2)

 Clinical information systems

● “I pay more attention to the panel management tool where I can look at the patient inactivity report…and I can look to see whether patients have been seen in the last two years and then we can look at potentially discharging them due to inactivity…whereas before I didn’t have access to this type of data” (Psychologist Time 2)

● “We’ve starting to think about measurement-based care here…it’s been a topic of conversation within our team… I know we are exploring various measurements that we could use or we think would be beneficial” (Vocational Rehabilitation Counselor Time 2)

 Community linkages

● “We’re doing a better job of informing our patients about community resources. We actually have a community resource guide that we’re able to share with patients now…it’s available for all providers on the team” (Psychologist Time 2)

● “The social worker that left was one that was very versed in pretty much everything…so when we needed a community resource and we didn’t know, we would go to her. That person is gone and even though we have her contact list, you can’t figure it all out. There are probably things we’re not aware of.” (Nurse Time 2)

 Organization and leadership support

● “I spoke with one executive leader and she complimented our work, so I know they are aware but they are not right up in our business” (Nurse Time 2)

● “Executive leadership really doesn’t get it…they kind of miss the mark and they are looking at numbers versus people…facts versus what’s helpful and healthy for the staff” (Psychologist Time 2)

● “One of the things we learned is getting your leadership on board is pretty important with this implementation because you need them involved in some of the CCM components like liaising across services… unfortunately the leader supporting us left and it’s gone in a different direction…leadership is shooting down certain aspects of [the CCM] which is a bit disempowering” (Psychologist Time 2)

 Provider decision support

● “our team has been extremely well trained…our therapists, each of them, have at least one of the VA evidence-based therapies under their belt. Most of them have more than one. So we have CBTI, a specialist and somebody that's CBT pain and then we have interpersonal therapy. So anyway, I don't think there's any new ones but we were really well stacked in that to begin with.” (Vocational Rehabilitation Specialist Time 2)

● “not really any changes in expert consultation except that a lot of times in the past before [CCM implementation], like whoever met with resistance from another consulting service that wouldn’t take our patient or something, it was just kind of – it would just stop and now if there’s some resistance, one of us might bring it to the team and then as a team we’ll – the team decides ‘no, it’s still a good idea’, then we’ll document that and it’s been able to help us get more care for the patient than not just one person recommending person, it’s all of us….. I feel more comfortable reaching out to other disciplines because of the teams we have the backup there… I’m closer to my own team knowing what resources they can provide”. (Clinical Pharmacist Specialist Time 2)