Rationale, aims and objectives Patient involvement is increasingly recognized as a key component on the international health care agenda. This attention has brought a need for developing generic and standardized open-source methods, tools, and guidelines on how to systematically implement patient involvement initiatives in the clinical setting. The large-scale project the User-involving Hospital was initiated to implement two systematic methods for patient involvement at a Danish university hospital, but the required methods can only be implemented if embraced by the health professionals. This evaluation study aimed to explore the health professional perspective on the development and implementation of shared decision making (SDM) and user-led health care. Specifically, the objectives were to identify the most crucial preconditions for success and to translate the findings into practice recommendations. Method The study was based on a simple questionnaire survey and a qualitative descriptive analysis of semistructured focus group interviews with representatives of 21 multidisciplinary clinical teams (nine interviews) and 18 health professional department managers (six interviews). Results Two years after the initiation of the User-involving Hospital, 13 out of 21 developed patient involvement initiatives were fully incorporated into clinical practice. Five domains were found significant for successful development and implementation of the patient involvement methods: the patients' perspectives, composition of multidisciplinary teams, bottom-up and skill building, support from management, and information sharing with colleagues. Conclusions The findings draw attention to several significant factors for successful implementation of large-scale patient involvement initiatives in hospitals, including the importance of having both a top-down and bottom-up approach and of active listening to the patients' perspectives. On the basis of these findings, the study outlines four recommendations incorporating the five identified key domains, which may inspire future projects on systematic development and implementation of patient-involvement initiatives based on either shared decision making or user-led health care in the clinical setting.
