Task overlap among primary care team members: an opportunity for system redesign?

This article presents the results of research on a systematic approach to the assignment of primary care work in the Veterans Health Administration. Based on a functional job analysis protocol, the study identified overlap in the performance of primary care tasks among multiple occupational groups as prima facie evidence of opportunities to reallocate work responsibilities. Results show that registered nurses, physicians, advanced practitioners, and licensed vocational nurses reported performing 60 percent to 97 percent of the same tasks, while clerks and health technicians appeared to be underutilized. The frequency and duration with which occupational groups performed each task were also examined, providing additional evidence to be used in improving clinic efficiency. The management of healthcare personnel can be improved through systematic analysis of the work, the worker, and the work organization and through more informed decisions about the appropriateness of task assignment (or reassignment). This article presents an evidence-based approach to personnel management with important implications for clinic efficiency. The approach can be used to guide strategic planning and staffing decisions by identifying not only who currently does the work but, more importantly, who should be doing the work given the full array of data.