Teamwork and Delegation in Medical Homes: Primary Care Staff Perspectives in the Veterans Health Administration

True, Gala; Stewart, Greg L.; Lampman, Michelle A.; Pelak, Mary; Solimeo, Samantha L.

doi:10.1007/s11606-013-2666-z

Cited by 46 publications

(46 citation statements)

References 28 publications

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“…Qualitative research with VHA primary care providers implementing the PACT model in a large Midwestern region demonstrates the importance of multi-level alignment of implementation ideals with organizational practices. 14 The primary care providers we interviewed were generally enthusiastic about the potential of the PACT model to improve care, and a majority readily adopted PACT strategies such as encounterless encounters. However, providers who were more successful at creating open access often experienced negative reinforcement from having to see patients of other primary care providers and from performance metrics that rewarded providers for full appointment calendars regardless of whether those appointments were in line with PACT ideals.…”

Section: Discussionmentioning

confidence: 99%

“…Recent publications reporting on VHA PACT implementation emphasize the importance of supportive leadership on PACT team function, 1,12,14 particularly with regard to sustaining same day access gains 3 and improving panel management. As Murray and Tantau reported in 2000, primary care providers' efforts to provide continuity and same-day access must be organizationally valued and protected.…”

Section: Discussionmentioning

confidence: 99%

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Implementing a patient centered medical home in the Veterans health administration: Perspectives of primary care providers

Solimeo

Stewart

et al. 2014

Healthcare

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Implementing a patient centered medical home in the Veterans health administration: Perspectives of primary care providers

Solimeo

Stewart

et al. 2014

Healthcare

Self Cite

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“…1,[9][10][11][12] By observing PACTs in the clinic and at training events, and by interviewing staff one-on-one, we developed an understanding of how clerks contribute to care. 1,9,10,13 These observations have provided a basis for our developing and sharing the following key insights and suggestions related to the potential for clerks to improve care quality.…”

Section: Clerks In the Veterans Health Administration Experiencementioning

confidence: 99%

The Critical Role of Clerks in the Patient-Centered Medical Home

Solimeo

Stewart

Rosenthal

2016

The Annals of Family Medicine

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Research evaluating the effectiveness, function, and implementation of patientcentered medical homes (PCMHs) has found major socioprofessional transformations and contributions of primary care physicians and, to a lesser degree, nurses. Our longitudinal ethnographic research with teams implementing PCMH in Veterans Health Administration (VHA) primary care identifies the important but largely under utilized contributions of clerks to PCMH outcomes. Although the relationship of high-performing clerical staff to patient satisfaction is widely acknowledged, PCMH can be further enhanced by enabling clerks to use administrative tasks as conduits for investing in long-term personalized relationships with patients that foster trust in the PCMH and the broader health care organization. Such relationships are engendered through the care-coordination activities clerks perform, which may be bolstered by organizational investment in clerks as skilled health care team members. 2016;14:377-379. doi: 10.1370/afm.1934. Ann Fam Med INTRODUCTIONT he patient-centered medical home (PCMH) has emerged as a promising strategy for revitalizing primary care. The model seeks to improve chronic disease management, care coordination across clinicians and delivery systems, and patient access. At the heart of the model is the structuring of health care delivery around interdisciplinary teams that promote interprofessional competence and in which team members strive to practice at the top of their professional license or competence. 1 Initial studies suggest that the PCMH model may improve quality of care, lower health care costs through decreases in hospital admissions and emergency department visits, and increase clinician and patient satisfaction. 2,3 In tandem, evaluations of the PCMH have highlighted the transformation of roles and associated PCMH-specific educational needs of clinically trained staff, such as primary care physicians and nurses. 1,4,5 In contrast, attention to the role and training of the nonclinically trained team member-primary care clerks-has been exceptionally scant outside their inclusion in measures of patient satisfaction with telephone and scheduling practices. Social scientists have documented primary care front office staff efforts to reduce patient emotional distress and to advocate for service on patients' behalf in traditional primary care settings, 6-8 but to our knowledge there has been no substantive attention paid to the nature and importance of clerks' role under the team-based PCMH model. and an administrative associate, informally referred to as a clerk. VHA clerks perform administrative duties similar to those of front office staff in private sector settings, eg, greet patients, verify patients' demographic and payer information in the electronic health record, answer and route incoming queries and telephone calls, place appointment reminder calls, and manage reception area climate. Yet these clerks differ from traditional front office staff in that they are considered fully engaged members of...

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“…The role of teams was of specific interest to several committee members, given recent work in surgical care, 22 patient safety, 23 and primary care. 24 Creating incentives for individual clinicians might produce suboptimal outcomes, especially when care coordination is important. While much of the discussion focused on provider incentives, we were eager to see more research on incentives that encourage healthful behaviors among patients.…”

Section: Priorities For Future Researchmentioning

confidence: 99%

Opportunities to Enhance Value-Related Research in the U.S. Department of Veterans Affairs

et al. 2016

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Teamwork and Delegation in Medical Homes: Primary Care Staff Perspectives in the Veterans Health Administration

Cited by 46 publications

References 28 publications

Implementing a patient centered medical home in the Veterans health administration: Perspectives of primary care providers

Implementing a patient centered medical home in the Veterans health administration: Perspectives of primary care providers

The Critical Role of Clerks in the Patient-Centered Medical Home

Opportunities to Enhance Value-Related Research in the U.S. Department of Veterans Affairs

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