Delegation of Work Within a Patient-Centered Medical Home

Abstract

The aim of this study was to analyze the perceptions of core team members implementing patient-centered medical home (PCMH) within the Veterans Health Administration regarding delegation of work. BACKGROUND: Significant overlap exists in the performance of work tasks among PCMH team members (primary care providers, RNs, clinical associates, clerks), and scant literature exists on appropriate delegation within PCMH teams. METHODS: This study conducted used a quantitative and qualitative analysis of 4254 respondents to a 2018 survey. RESULTS: Primary care providers rely heavily on team members, and nurses report being relied upon at high levels. Lack of role clarity and a perceived need for a team leader were concerns voiced by participants. CONCLUSIONS: Findings indicated a need for clear guidance on roles and responsibilities within the team. Patient-centered medical home team members need information about the scope of practice of each professional group to allow providers to function at the top of their scope of practice and ensure effective delegation.

Perceptions of Responsibilities by Primary Care Staff in a Patient-Centered Medical Home

“…The qualitative findings in this study are consistent with our previous findings regarding this population. 6,7 Respondents in earlier surveys using similar questions Immunizations, patient intake, vitals.…”

“…X X emphasized the importance of teamwork, working to the top of their competency, 7 and need for role clarity 6 for effective team function. Unfortunately, this team does not have data regarding the perceptions of who should do the work in the prior surveys, but rather who was relied upon.…”

“…However, prior work within the VHA found issues with role clarity within the team. [4][5][6][7] Team members report challenges with optimizing member roles specifically relating to appropriate delegation or division of work within the team. Although PCPs rely heavily on team members and nurses report being relied upon…”

“…to accomplish the goals of PACT, 6 team members seem unclear about what and to whom work should be delegated. 7 Furthermore, the delegation and division of labor on PACT teams can vary according to PCP knowledge of the differing nursing roles of RNs and LPNs.…”

“…The PACT team model emphasizes the importance of teamwork to coordinate and manage veterans care. However, prior work within the VHA found issues with role clarity within the team 4-7 . Team members report challenges with optimizing member roles specifically relating to appropriate delegation or division of work within the team.…”