Barriers and facilitators to expanding roles of medical assistants in patient-centered medical homes (PCMHS)

Jeanne Ferrante, Eric K. Shaw, Jennifer E. Bayly, Jenna Howard, M. Nell Quest, Elizabeth Clark, Connie Pascal

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Many primary care practices participating in patient-centered medical home (PCMH) transformation initiatives are expanding the work roles of their medical assistants (MAs). Little is known about attitudes of MAs or barriers and facilitators to these role changes. Methods: Secondary data analysis of qualitative cross-case comparison study of 15 New Jersey primary care practices participating in a PCMH project during 2012 to 2013. Observation field notes and in-depth and key informant interviews (with physicians, office managers, staff and care coordinators) were iteratively analyzed using grounded theory. Results: MA roles and responsibilities changed from a mostly reactive role, completing tasks dependent on physician orders during the patient visit and facilitating patient flow through the office, to a more proactive one, conducting previsit planning, engaging in the overall care for patients, and assisting with population management. MAs differed in their attitudes about increased responsibilities, with some welcoming the opportunity to take on expanded roles, others resenting their increased responsibilities, and some expressing insufficient understanding regarding why new tasks and procedures were being implemented. Major barriers to MA role shifts included 1) insufficient understanding of the PCMH concept, 2) lack of time for added responsibilities, 3) additional workload without additional compensation, 4) disparate levels of medical knowledge and training, 5) reluctance of clinicians to delegate tasks, 6) uncertainty in making new workflow changes routine, 7) staff turnover, and 8) change fatigue. MAs were more positive about their role shifts when they 1) understood how their responsibilities fit within broader PCMH practice transformation goals; 2) received formal training in new tasks; 3) had detailed protocols and standing orders; 4) initiated role changes with small, achievable goals; 5) had open communication with clinicians and practice leaders; and 5) received additional compensation or paths to career advancement. Conclusions: Practice leaders need to be conscious of obstacles when they increase expectations of MAs, and they must be willing to invest time and resources into developing their MA workforce. An environment that allows open dialog with MAs and rewards and compensation that recognizes their increased efforts will help make expansion of MA roles occur more smoothly and efficiently.

Original languageEnglish (US)
Pages (from-to)226-235
Number of pages10
JournalJournal of the American Board of Family Medicine
Volume31
Issue number2
DOIs
StatePublished - Mar 1 2018

Fingerprint

Patient-Centered Care
Primary Health Care
Physicians' Offices
Workflow
Workload
Reward
Uncertainty
Fatigue
Case-Control Studies
Patient Care
Communication
Observation
Interviews
Physicians
Population
Practice (Psychology)

All Science Journal Classification (ASJC) codes

  • Public Health, Environmental and Occupational Health
  • Family Practice

Keywords

  • Grounded theory
  • New Jersey
  • Patient-centered care
  • Primary health care

Cite this

Ferrante, Jeanne ; Shaw, Eric K. ; Bayly, Jennifer E. ; Howard, Jenna ; Quest, M. Nell ; Clark, Elizabeth ; Pascal, Connie. / Barriers and facilitators to expanding roles of medical assistants in patient-centered medical homes (PCMHS). In: Journal of the American Board of Family Medicine. 2018 ; Vol. 31, No. 2. pp. 226-235.
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abstract = "Background: Many primary care practices participating in patient-centered medical home (PCMH) transformation initiatives are expanding the work roles of their medical assistants (MAs). Little is known about attitudes of MAs or barriers and facilitators to these role changes. Methods: Secondary data analysis of qualitative cross-case comparison study of 15 New Jersey primary care practices participating in a PCMH project during 2012 to 2013. Observation field notes and in-depth and key informant interviews (with physicians, office managers, staff and care coordinators) were iteratively analyzed using grounded theory. Results: MA roles and responsibilities changed from a mostly reactive role, completing tasks dependent on physician orders during the patient visit and facilitating patient flow through the office, to a more proactive one, conducting previsit planning, engaging in the overall care for patients, and assisting with population management. MAs differed in their attitudes about increased responsibilities, with some welcoming the opportunity to take on expanded roles, others resenting their increased responsibilities, and some expressing insufficient understanding regarding why new tasks and procedures were being implemented. Major barriers to MA role shifts included 1) insufficient understanding of the PCMH concept, 2) lack of time for added responsibilities, 3) additional workload without additional compensation, 4) disparate levels of medical knowledge and training, 5) reluctance of clinicians to delegate tasks, 6) uncertainty in making new workflow changes routine, 7) staff turnover, and 8) change fatigue. MAs were more positive about their role shifts when they 1) understood how their responsibilities fit within broader PCMH practice transformation goals; 2) received formal training in new tasks; 3) had detailed protocols and standing orders; 4) initiated role changes with small, achievable goals; 5) had open communication with clinicians and practice leaders; and 5) received additional compensation or paths to career advancement. Conclusions: Practice leaders need to be conscious of obstacles when they increase expectations of MAs, and they must be willing to invest time and resources into developing their MA workforce. An environment that allows open dialog with MAs and rewards and compensation that recognizes their increased efforts will help make expansion of MA roles occur more smoothly and efficiently.",
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Barriers and facilitators to expanding roles of medical assistants in patient-centered medical homes (PCMHS). / Ferrante, Jeanne; Shaw, Eric K.; Bayly, Jennifer E.; Howard, Jenna; Quest, M. Nell; Clark, Elizabeth; Pascal, Connie.

In: Journal of the American Board of Family Medicine, Vol. 31, No. 2, 01.03.2018, p. 226-235.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Barriers and facilitators to expanding roles of medical assistants in patient-centered medical homes (PCMHS)

AU - Ferrante, Jeanne

AU - Shaw, Eric K.

AU - Bayly, Jennifer E.

AU - Howard, Jenna

AU - Quest, M. Nell

AU - Clark, Elizabeth

AU - Pascal, Connie

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N2 - Background: Many primary care practices participating in patient-centered medical home (PCMH) transformation initiatives are expanding the work roles of their medical assistants (MAs). Little is known about attitudes of MAs or barriers and facilitators to these role changes. Methods: Secondary data analysis of qualitative cross-case comparison study of 15 New Jersey primary care practices participating in a PCMH project during 2012 to 2013. Observation field notes and in-depth and key informant interviews (with physicians, office managers, staff and care coordinators) were iteratively analyzed using grounded theory. Results: MA roles and responsibilities changed from a mostly reactive role, completing tasks dependent on physician orders during the patient visit and facilitating patient flow through the office, to a more proactive one, conducting previsit planning, engaging in the overall care for patients, and assisting with population management. MAs differed in their attitudes about increased responsibilities, with some welcoming the opportunity to take on expanded roles, others resenting their increased responsibilities, and some expressing insufficient understanding regarding why new tasks and procedures were being implemented. Major barriers to MA role shifts included 1) insufficient understanding of the PCMH concept, 2) lack of time for added responsibilities, 3) additional workload without additional compensation, 4) disparate levels of medical knowledge and training, 5) reluctance of clinicians to delegate tasks, 6) uncertainty in making new workflow changes routine, 7) staff turnover, and 8) change fatigue. MAs were more positive about their role shifts when they 1) understood how their responsibilities fit within broader PCMH practice transformation goals; 2) received formal training in new tasks; 3) had detailed protocols and standing orders; 4) initiated role changes with small, achievable goals; 5) had open communication with clinicians and practice leaders; and 5) received additional compensation or paths to career advancement. Conclusions: Practice leaders need to be conscious of obstacles when they increase expectations of MAs, and they must be willing to invest time and resources into developing their MA workforce. An environment that allows open dialog with MAs and rewards and compensation that recognizes their increased efforts will help make expansion of MA roles occur more smoothly and efficiently.

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KW - Grounded theory

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