Overcoming Challenges to Teamwork in Patient-Centered Medical Homes: A Qualitative Study

O’Malley, Ann S.; Gourevitch, Rebecca; Draper, Kevin; Bond, Amelia M.; Tirodkar, Manasi A.

doi:10.1007/s11606-014-3065-9

Cited by 77 publications

(82 citation statements)

References 16 publications

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“…Strategies previously suggested, and also used in our practices, include using a teamlet model (of the same clinician-MA dyad each day) 12 , which increases physician comfort level with expanded MA roles 1 , and having morning huddles for collaborative previsit planning. 28 Martinez et al 29 described a "shareport" card that facilitates face-toface meetings between physicians and MAs, providing opportunities to collaboratively develop a list of MA tasks and explore and solve problems. Furthermore, to sustain changes to the MA role and retain MAs in practices, investments in time and resources are needed to develop the new MA workforce.…”

Section: Discussionmentioning

confidence: 99%

Barriers and Facilitators to Expanding Roles of Medical Assistants in Patient-Centered Medical Homes (PCMHs)

et al. 2018

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Background: Many primary care practices participating in patient-centered medical home (PCMH) transformation initiatives are expanding the work roles of their medical assistants (MAs). Little is known about attitudes of MAs or barriers and facilitators to these role changes.Methods: Secondary data analysis of qualitative cross-case comparison study of 15 New Jersey primary care practices participating in a PCMH project during 2012 to 2013. Observation field notes and in-depth and key informant interviews (with physicians, office managers, staff and care coordinators) were iteratively analyzed using grounded theory.Results: MA roles and responsibilities changed from a mostly reactive role, completing tasks dependent on physician orders during the patient visit and facilitating patient flow through the office, to a more proactive one, conducting previsit planning, engaging in the overall care for patients, and assisting with population management. MAs differed in their attitudes about increased responsibilities, with some welcoming the opportunity to take on expanded roles, others resenting their increased responsibilities, and some expressing insufficient understanding regarding why new tasks and procedures were being implemented.

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Section: Discussionmentioning

confidence: 99%

Barriers and Facilitators to Expanding Roles of Medical Assistants in Patient-Centered Medical Homes (PCMHs)

et al. 2018

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“…Effective activity planning and communication among those involved are important tools in this process. 31 When the multiprofessional team feels respected and motivated, it is able to establish more meaningful and healthy interpersonal relationships with the family of the patients. 18 In turn, positive interactions between the health team and the family can help these people overcome difficulties and suffering which occur in the NICU.…”

Section: Discussionmentioning

confidence: 99%

Forças Que Interferem Na Maternagem Em Unidade De Terapia Intensiva Neonatal

Santos

Souza²,

Mutti³

et al. 2017

Texto contexto - enferm.

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Objective: to identify the driving and restrictive forces involved in the maternity process for newborns hospitalized in a neonatal intensive care unit.Method: descriptive and exploratory research, with a qualitative approach, which uses the Force Field Theory as a reference. Ten mothers participated. Data were collected from September to December 2014, through a semi-structured interview, and submitted to content analysis.Results: effective communication, inclusion of the family in care, teamwork, learning and adequate physical space served as forces that fostered mothering. Authoritative behaviors, stigmas related to the neonatal intensive care unit, lack of specialized care, failure to perform care for the newborn, physical fatigue, emotional stress and changes in the daily routine acted as forces that restricted the mothering process.Conclusion: identifying the field of forces made it possible to understand factors and situations that influence mothering and to diagnose the true biopsychosocial demands of mothers of hospitalized newborns. Resultados: comunicación efectiva, inclusión de la familia en el cuidado, trabajo en equipo, aprendizaje y espacio físico adecuado actuaron como fuerzas que impulsaron la maternidad. Las conductas autoritarias, estigmas relacionadas con la unidad de terapia intensiva neonatal, falta de asistencia especializada, no realizar cuidados al recién nacido, cansancio físico, estrés emocional y cambios en la rutina diaria actuaron como fuerzas que restringieron la maternidad. DESCRIPTORS:Conclusión: identificar el campo de fuerzas posibilitó comprender factores y situaciones que influencian la maternidad y diagnosticar las verdaderas demandas biopsicosociales de las madres de los recién nacidos hospitalizados.DESCRIPTORES: Niño hospitalizado. Conducta materna. Relaciones madre-hijo. Relaciones profesional-familia. Unidades de cuidado intensivo neonatal.

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“…27 Leadership can play a vital role in promoting teamwork 28,29 by engaging members into collaborative efforts and changing the organizational structures to better meet patients' and providers' needs. 22,30,31 Despite the attention in recent years on primary care teams, we lack empirical evidence about how to promote teamwork. Moreover, there is no evidence regarding how NP autonomy-defined in the literature as NPs' ability to make independent care decisions 15 -or how the relationships NPs have with leadership influence teamwork between NPs and physicians.…”

Section: Introductionmentioning

confidence: 99%

Nurse Practitioner Autonomy and Relationships with Leadership Affect Teamwork in Primary Care Practices: a Cross-Sectional Survey

Poghosyan

Liu

2016

J GEN INTERN MED

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BACKGROUND:The Nurse Practitioner (NP) workforce represents a substantial supply of primary care providers able to contribute to meeting a growing demand for care. However, controversy exists regarding the expanding role of NPs in primary care in terms of challenging the teamwork between NPs and physicians. To date, no empirical evidence exists regarding how to promote teamwork in primary care between NPs and physicians. OBJECTIVE: We investigated whether NP autonomy within primary care practices and the relationships they have with leadership affect teamwork between NPs and physicians. DESIGN: Using a cross-sectional survey design, data was collected from 163 p ri mary care practices in Massachusetts. PARTICIPANTS: Three hundred and fourteen primary care NPs completed and returned the mail survey yielding a response rate of 40 %. MAIN MEASURES: The Autonomy and Independent Practice (AIP) and NP-Administration Relations (NP-AR) scales were used to measure NP independent practice and the relationships with leadership, respectively. These measures were aggregated to the practice level. Teamwork between NPs and physicians was measured at the individual NP level using the Teamwork (TW) scale. KEY RESULTS: The multilevel linear regression models investigated the influence of practice-level NP autonomy and the relationship between NPs and leadership on teamwork. With every unit increase on the practice-level mean score of AIP centered at the grand mean, the mean TW score increased by 0.271 units (p < 0.0001). With every unit increase of NP-AR centered at the grand mean, the mean TW score increased by 0.375 (p < 0.001). Over one-third (41.3 %) of the variance in teamwork could be explained by the final model. CONCLUSION: The study findings demonstrate that NP autonomy and favorable relationships with leadership improve teamwork. Policy and organizational change should focus on promoting NP autonomy and improving the relationship between NPs and leadership to improve teamwork and consequently improve patient care and outcomes.

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Overcoming Challenges to Teamwork in Patient-Centered Medical Homes: A Qualitative Study

Cited by 77 publications

References 16 publications

Barriers and Facilitators to Expanding Roles of Medical Assistants in Patient-Centered Medical Homes (PCMHs)

Barriers and Facilitators to Expanding Roles of Medical Assistants in Patient-Centered Medical Homes (PCMHs)

Forças Que Interferem Na Maternagem Em Unidade De Terapia Intensiva Neonatal

Nurse Practitioner Autonomy and Relationships with Leadership Affect Teamwork in Primary Care Practices: a Cross-Sectional Survey

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