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The empowerment paradox as a central challenge to patient centered medical home implementation in the veteran's health administration.
J Interprof Care. 2015 Jan; 29(1):26-33.JI

Abstract

In this paper we present results of a mixed methods study conducted to identify barriers to team function among staff implementing patient aligned care teams - the Department of Veterans Affairs' patient centered medical home (PCMH) model. Using a convergent mixed methods design, we administered a standardized survey measure (Team and Individual Role Perception Survey) to assess work role challenge and engagement; and conducted discussion groups to gather context pertaining to role change. We found that the role of primary care providers is highly challenging and did not become less difficult over the initial year of implementation. Unexpectedly over the course of the first year nurse care managers reported a decrease in their perceptions of empowerment and clerical associates reported less skill variety. Qualitative data suggest that more skilled team members fail to delegate and share tasks within their teams. We characterize this interprofessional knowledge factor as an empowerment paradox where team members find it difficult to share tasks in ways that are counter to traditionally structured hierarchical roles. Health care systems seeking to implement PCMH should dedicate resources to facilitating within-team role knowledge and negotiation.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Solimeo SL
Department of Veteran Affairs, VISN 23 Patient Aligned Care Team Demonstration Lab , Iowa City , USA .
Ono SS
No affiliation info available
Lampman MA
No affiliation info available
Paez MB
No affiliation info available
Stewart GL
No affiliation info available

MeSH

Attitude of Health PersonnelCommunicationConflict, PsychologicalHumansPatient Care TeamPatient-Centered CarePower, PsychologicalPrimary Health CareProfessional RoleUnited StatesUnited States Department of Veterans AffairsWorkload

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25052920

Citation

Solimeo, Samantha L., et al. "The Empowerment Paradox as a Central Challenge to Patient Centered Medical Home Implementation in the Veteran's Health Administration." Journal of Interprofessional Care, vol. 29, no. 1, 2015, pp. 26-33.
Solimeo SL, Ono SS, Lampman MA, et al. The empowerment paradox as a central challenge to patient centered medical home implementation in the veteran's health administration. J Interprof Care. 2015;29(1):26-33.
Solimeo, S. L., Ono, S. S., Lampman, M. A., Paez, M. B., & Stewart, G. L. (2015). The empowerment paradox as a central challenge to patient centered medical home implementation in the veteran's health administration. Journal of Interprofessional Care, 29(1), 26-33. https://doi.org/10.3109/13561820.2014.937480
Solimeo SL, et al. The Empowerment Paradox as a Central Challenge to Patient Centered Medical Home Implementation in the Veteran's Health Administration. J Interprof Care. 2015;29(1):26-33. PubMed PMID: 25052920.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The empowerment paradox as a central challenge to patient centered medical home implementation in the veteran's health administration. AU - Solimeo,Samantha L, AU - Ono,Sarah S, AU - Lampman,Michelle A M, AU - Paez,Monica B W, AU - Stewart,Gregory L, Y1 - 2014/07/23/ PY - 2014/7/24/entrez PY - 2014/7/24/pubmed PY - 2016/11/3/medline KW - Health and social care KW - interprofessional collaboration KW - mixed methods KW - patient centered practice KW - professional identity KW - team-based care SP - 26 EP - 33 JF - Journal of interprofessional care JO - J Interprof Care VL - 29 IS - 1 N2 - In this paper we present results of a mixed methods study conducted to identify barriers to team function among staff implementing patient aligned care teams - the Department of Veterans Affairs' patient centered medical home (PCMH) model. Using a convergent mixed methods design, we administered a standardized survey measure (Team and Individual Role Perception Survey) to assess work role challenge and engagement; and conducted discussion groups to gather context pertaining to role change. We found that the role of primary care providers is highly challenging and did not become less difficult over the initial year of implementation. Unexpectedly over the course of the first year nurse care managers reported a decrease in their perceptions of empowerment and clerical associates reported less skill variety. Qualitative data suggest that more skilled team members fail to delegate and share tasks within their teams. We characterize this interprofessional knowledge factor as an empowerment paradox where team members find it difficult to share tasks in ways that are counter to traditionally structured hierarchical roles. Health care systems seeking to implement PCMH should dedicate resources to facilitating within-team role knowledge and negotiation. SN - 1469-9567 UR - https://www.unboundmedicine.com/medline/citation/25052920/The_empowerment_paradox_as_a_central_challenge_to_patient_centered_medical_home_implementation_in_the_veteran's_health_administration_ DB - PRIME DP - Unbound Medicine ER -