Overcoming challenges to teamwork in patient-centered medical homes: a qualitative study.
BACKGROUND
There is emerging consensus that enhanced inter-professional teamwork is necessary for the effective and efficient delivery of primary care, but there is less practical information specific to primary care available to guide practices on how to better work as teams.


OBJECTIVE
The purpose of this study was to describe how primary care practices have overcome challenges to providing team-based primary care and the implications for care delivery and policy.


METHODS
Practices for this qualitative study were selected from those recognized as patient-centered medical homes (PCMHs) via the most recent National Committee for Quality Assurance PCMH tool, which included a domain on practice teamwork.


METHODS
Sixty-three respondents, ranging from physicians to front-desk staff, were interviewed from May through December of 2013. Practice respondents came from 27 primary care practices ranging in size, type, geography, and population served.


RESULTS
Practices emphasizing teamwork overcame common challenges through the incremental delegation of non-clinical tasks away from physicians. The roles of medical assistants and nurses are expanding to include template-guided information collection from patients prior to the physician office visit as well as many other tasks. The inclusion of staff input in care workflow redesign and the use of data to demonstrate how team care process changes improved patient care were helpful in gaining staff buy-in. Team "huddles" guided by pre-visit planning were reported to assist in role delegation, consistency of information collected from patients, and structured communication among team members. Nurse care managers were found to be important team members in working with patients and their physicians on care plan design and execution. Most practices had not participated in formal teamwork training, but respondents expressed a desire for training for key team members, particularly if they could access it on-site (e.g., via practice coaches or the Internet).


CONCLUSIONS
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. There appears to be a need for more on-site teamwork training.
Mathematica Policy Research, 1100 1st St., NE, 12th Floor, Washington, DC, 20002-4221, USA, aomalley@mathematica-mpr.com.
Ann S
AS
O'Malley
Rebecca
R
Gourevitch
Kevin
K
Draper
Amelia
A
Bond
Manasi A
MA
Tirodkar
D005260:Female; D006801:Humans; D008297:Male; D010348:Patient Care Team / Q000592:standards*; D018802:Patient-Centered Care / Q000379:methods / Q000592:standards*; D011320:Primary Health Care / Q000379:methods / Q000592:standards*; D036301:Qualitative Research