title: The Critical Role of Clerks in the Patient-Centered Medical Home.
abstract: Research evaluating the effectiveness, function, and implementation of patient-centered 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 underutilized 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.
authors.affiliation: VISN 23 Patient Aligned Care Team Demonstration Lab, and Center for Comprehensive Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa samantha.solimeo@va.gov.
authors.forename: Samantha L
authors.initials: SL
authors.lastname: Solimeo
authors.affiliation: VISN 23 Patient Aligned Care Team Demonstration Lab, and Center for Comprehensive Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa Tippie College of Business, University of Iowa, Iowa City, Iowa.
authors.forename: Greg L
authors.initials: GL
authors.lastname: Stewart
authors.affiliation: VISN 23 Patient Aligned Care Team Demonstration Lab, and Center for Comprehensive Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa.
authors.forename: Gary E
authors.initials: GE
authors.lastname: Rosenthal
mesh_terms: D006801:Humans; D010348:Patient Care Team / Q000458:organization & administration*; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D011369:Professional-Patient Relations; D014481:United States; D014493:United States Department of Veterans Affairs
keywords: implementation; patient-centered medical home; primary care; receptionists; team-based care