VA HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA; Department of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA.
University of California, Berkeley School of Public Health, USA.
Healthc (Amst). 2019 Jun;7(2):10-15. doi: 10.1016/j.hjdsi.2018.11.003. Epub 2019 Feb 11.
The Veterans Health Administration (VA) primary care is organized as a Patient Centered Medical Home (PCMH) that is based on continuity management of patient panels by interdisciplinary "teamlets" consisting of primary care providers, nurses, and clerical associates. While the teamlets are envisioned as interdisciplinary in this model, teamlet members may continue to report separately to middle management supervisors within their respective disciplines. Little is known about the role of middle managers in medical home implementation; therefore, the study purpose is to examine and characterize teamlet members' perceptions of middle managers' role in primary care operations and teamlet functioning in an outpatient setting.
This study applied a formal qualitative data collection method and analysis based on semi-structured interviews of 79 frontline interdisciplinary staff (primary care providers, nurses, and clerical associates) in VA Patient Aligned Care Teams (PACT) teamlets. Interviews were analyzed using a method of constant comparison.
Teamlet members recognize that their supervising middle managers are essential to daily functioning of PACT teamlets in terms of clarifying roles and responsibilities, setting expectations, providing coverage strategies, supporting conflict resolution, and facilitating teamlet-initiated innovation. Teamlet members identified challenges when middle manager involvement was lacking.
Within a multilevel system, frontline interdisciplinary staff continue to perceive the need for leadership by middle managers from their own professional disciplines for solving interdisciplinary problems, setting role-specific schedules and expectations, and fostering innovation. As such, greater focus on the structure and training of middle managers for participation in PCMH models is needed.
退伍军人健康管理局（VA）的初级保健组织为以患者为中心的医疗之家（PCMH），其基础是由跨学科的“团队”对患者小组进行连续管理，团队由初级保健提供者、护士和文书助理组成。虽然该模型中设想团队为跨学科性质，但团队成员可能继续向各自学科的中层管理人员报告。关于中层管理人员在医疗之家实施中的作用知之甚少；因此，本研究的目的是考察和描述初级保健运营中团队成员对中层管理人员角色的看法以及团队在门诊环境中的运作。
本研究采用正式的定性数据收集方法和基于对退伍军人事务部患者一致护理团队（PACT）团队中 79 名一线跨学科工作人员（初级保健提供者、护士和文书助理）的半结构化访谈的分析。使用恒比法对访谈进行分析。
团队成员认识到，他们的中层监督管理人员对于 PACT 团队的日常运作至关重要，这体现在明确角色和职责、设定期望、提供覆盖策略、支持冲突解决以及促进团队发起的创新方面。当中层管理人员缺乏参与时，团队成员就会遇到挑战。
在多层次系统中，一线跨学科工作人员继续认为需要来自他们自己专业领域的中层管理人员进行领导，以解决跨学科问题、制定特定角色的时间表和期望，并促进创新。因此，需要更加关注中层管理人员的结构和培训，以参与 PCMH 模式。
