Ann S. O’Malley, Rebecca Gourevitch, Kevin Draper, Amelia Bond, and Manasi A. Tirodkar
A. S. O’Malley, R. Gourevitch, K. Draper et al., “Overcoming Challenges to Teamwork in Patient-Centered Medical Homes: A Qualitative Study,” Journal of General Internal Medicine, published online Nov. 11, 2014.
A study of medical practices recognized as patient-centered medical homes found that a team approach to primary care was fostered by: delegating more of physicians’ nonclinical tasks to other staff; soliciting staff input on workflow modifications and feeding back data to the team; expanding the roles of medical assistants and nurses; and holding regular team “huddles.”
“Participants who adopted new forms of delegation and care processes using teamwork approaches, and who were supported with resources, system support, and data feedback, reported improved provider satisfaction and productivity.”
A team approach to primary care—typically involving a lead clinician, nurses, medical assistants, care managers, and clerical staff—can help practices deliver services more efficiently, improve patients’ access to care, and reduce physician burnout. However, providers lack practical guidance on how to function as a team. Commonwealth Fund–supported researchers interviewed 63 clinicians and other staff from 27 primary care practices to find out how they sought to overcome challenges to providing team-based care.
Most problematic for the primary care practices in the study were broader health system challenges beyond their control—among them the inadequacy of the fee-for-service payment system for reimbursing practices for certain medical home services. In these instances, practices try to turn to effective clinical leaders who have training in changing care processes.
The researchers selected a random sample of patient-centered medical homes in different geographic regions from a National Committee for Quality Assurance (NCQA) database. Most of the 27 practices interviewed received a high score on NCQA’s “practice team element,” but the sample also included one low-scoring practice per region for comparison. Practice team members, ranging from physicians to front-desk staff, were interviewed between May and December 2013.
Enhanced teamwork can increase provider satisfaction and productivity within primary care practices, but more staff training—preferably on-site—is necessary.