BACKGROUND: The Veterans Health Administration (VHA) is changing its primary care delivery by implementing the patient-centered medical home (PCMH). OBJECTIVES: To evaluate PCMH implementation among 22 newly formed teams working in the VHA. STUDY DESIGN: Longitudinal formative evaluation of team members' role transformation during the first 18 months of implementation. METHODS: We used 3 sequential, semistructured focus groups to gather data from 4 different groups representing the principal team member roles: primary care providers, registered nurse care managers, licensed practical nurses, and clerical associates. RESULTS: Team members identified within-team role and interpersonal conflict, as well as discordant administrative leadership styles, as key implementation challenges. CONCLUSIONS: Our results suggest that, in addition to technological and fiscal infrastructure, healthcare leaders implementing the PCMH model must take into account interprofessional issues associated with changes in leadership and the adoption of team-based structures.
BACKGROUND: The Veterans Health Administration (VHA) is changing its primary care delivery by implementing the patient-centered medical home (PCMH). OBJECTIVES: To evaluate PCMH implementation among 22 newly formed teams working in the VHA. STUDY DESIGN: Longitudinal formative evaluation of team members' role transformation during the first 18 months of implementation. METHODS: We used 3 sequential, semistructured focus groups to gather data from 4 different groups representing the principal team member roles: primary care providers, registered nurse care managers, licensed practical nurses, and clerical associates. RESULTS: Team members identified within-team role and interpersonal conflict, as well as discordant administrative leadership styles, as key implementation challenges. CONCLUSIONS: Our results suggest that, in addition to technological and fiscal infrastructure, healthcare leaders implementing the PCMH model must take into account interprofessional issues associated with changes in leadership and the adoption of team-based structures.
Authors: Betty M Kennedy; Frederick Cerise; Ronald Horswell; Willene P Griffin; Kathleen H Willis; Sarah Moody-Thomas; Jay A Besse; Peter T Katzmarzyk Journal: Clin Transl Sci Date: 2014-07-25 Impact factor: 4.689
Authors: Jane Forman; Molly Harrod; Claire Robinson; Ann Annis-Emeott; Jessica Ott; Darcy Saffar; Sarah L Krein; Clinton L Greenstone Journal: J Gen Intern Med Date: 2014-07 Impact factor: 5.128
Authors: Anaïs Tuepker; Devan Kansagara; Eleni Skaperdas; Christina Nicolaidis; Sandra Joos; Michael Alperin; David Hickam Journal: J Gen Intern Med Date: 2014-07 Impact factor: 5.128