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How middle managers facilitate interdisciplinary primary care team functioning.
Healthc (Amst). 2019 Jun; 7(2):10-15.H

Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Giannitrapani KF
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. Electronic address: Karleen@Stanford.edu.
Rodriguez H
University of California, Berkeley School of Public Health, USA.
Huynh AK
VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
Hamilton AB
VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, Los Angeles, CA, USA.
Kim L
VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
Stockdale SE
VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, Los Angeles, CA, USA.
Needleman J
Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
Yano EM
VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
Rubenstein LV
Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA; The RAND Corporation, USA; UCLA David Geffen Medical School, USA.

MeSH

HumansInterviews as TopicLeadershipNevadaPatient Care TeamPatient-Centered CarePrimary Health CareQualitative ResearchUnited StatesUnited States Department of Veterans Affairs

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30765317

Citation

Giannitrapani, Karleen F., et al. "How Middle Managers Facilitate Interdisciplinary Primary Care Team Functioning." Healthcare (Amsterdam, Netherlands), vol. 7, no. 2, 2019, pp. 10-15.
Giannitrapani KF, Rodriguez H, Huynh AK, et al. How middle managers facilitate interdisciplinary primary care team functioning. Healthc (Amst). 2019;7(2):10-15.
Giannitrapani, K. F., Rodriguez, H., Huynh, A. K., Hamilton, A. B., Kim, L., Stockdale, S. E., Needleman, J., Yano, E. M., & Rubenstein, L. V. (2019). How middle managers facilitate interdisciplinary primary care team functioning. Healthcare (Amsterdam, Netherlands), 7(2), 10-15. https://doi.org/10.1016/j.hjdsi.2018.11.003
Giannitrapani KF, et al. How Middle Managers Facilitate Interdisciplinary Primary Care Team Functioning. Healthc (Amst). 2019;7(2):10-15. PubMed PMID: 30765317.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - How middle managers facilitate interdisciplinary primary care team functioning. AU - Giannitrapani,Karleen F, AU - Rodriguez,Hector, AU - Huynh,Alexis K, AU - Hamilton,Alison B, AU - Kim,Linda, AU - Stockdale,Susan E, AU - Needleman,Jack, AU - Yano,Elizabeth M, AU - Rubenstein,Lisa V, Y1 - 2019/02/11/ PY - 2018/05/17/received PY - 2018/09/28/revised PY - 2018/11/12/accepted PY - 2019/2/16/pubmed PY - 2020/1/30/medline PY - 2019/2/16/entrez KW - Patient-centered care KW - Patient-centered medical home KW - Primary care KW - Qualitative research KW - Veterans SP - 10 EP - 15 JF - Healthcare (Amsterdam, Netherlands) JO - Healthc (Amst) VL - 7 IS - 2 N2 - BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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. SN - 2213-0772 UR - https://www.unboundmedicine.com/medline/citation/30765317/How_middle_managers_facilitate_interdisciplinary_primary_care_team_functioning_ DB - PRIME DP - Unbound Medicine ER -