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

Abstract

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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