Delegation, technology, and training enabled our MAs – and doctors – to grow.
Fam Pract Manag. 2016 May-June;23(3):5-7.
Author disclosure: no relevant affiliations disclosed.
The “Triple Aim” envisioned by the Institute for Healthcare Improvement in 20081 and now embraced throughout our industry describes efforts to simultaneously improve population health, decrease per capita health care costs, and improve the patient experience of care. With rates of burnout among physicians now topping 50 percent, an additional dimension – improving the primary care provider experience – has further shaped a “Quadruple Aim.”2
Multiplying documentation demands and population health goals that make us responsible for the health of patients who don't see us feel particularly overwhelming. But there is reason for hope. A large percentage of what needs to be done does not require a medical degree. If we can develop support staff to manage most of our administrative work, then we can attain higher levels of productivity and work-life balance and enhance the care and experience of our patients. The challenge, of course, is how to make it work financially.
I was searching for ways to increase the capacity of the clinic where I serve as medical director when I heard Dr. Peter Anderson speak about having registered nurses take the initial patient history and review of systems and then act as scribes for the provider. (See “A New Approach to Making Your Doctor-Nurse Team More Productive, FPM, July/August 2008.) He also had broken away from the traditional model of one clinical assistant and two exam rooms per provider, increasing to two assistants and three exam rooms per provider, with clinical and financial success.
The idea of delegating work to a support team was attractive, but the model would have to be adjusted to our reality. We would be working with medical assistants (MAs), and it would be unreasonable to expect them to take medical histories. We subsequently implemented a model that leverages the broad abilities of our MAs, customized electronic health record (EHR) templates, and comprehensive and ongoing training. Here are the key characteristics.
Delegate a broad scope of tasks
First, don't underestimate the importance of making the MA feel like an integral part of your care team. This isn't just a task to check off when getting to know a new coworker but rather an ongoing responsibility that will directly affect your effectiveness and satisfaction. The most important factor in an MA's development is ongoing feedback from the provider with whom they closely work, and taking time to constructively deliver this feedback is a good way to show that you value the MA's role. (See “A Feedback Tool to Improve Physician-Medical Assistant Communication,” FPM, May/June 2014.)
Gradually and only after providing careful training (more on that later), we have delegated the following administrative tasks to our MAs:
Manage incoming messages with the provider during brief huddles between visits,
Manage incoming lab and radiology results,
Track labs for no-shows and cancellations,
Research refill requests – provide dates of last
1. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood). 2008;27(3):759–769.
2. Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014;12(6):573–576.
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