When a family medicine practice adopts the patient-centered medical home (PCMH) as a care model, that practice often undergoes change that impacts every member of its staff. That's according to recently published research that sought to understand and illustrate how practices undergoing this transformation achieved buy-in and full engagement among all staff members.
"Transitioning to a PCMH from more traditional models is not as simple as it may seem at face value," said William Bleser, M.S.P.H., research assistant for the Robert Wood Johnson Foundation's Aligning Forces for Quality project and the Center for Health Care and Policy Research at Pennsylvania State University in University Park and corresponding author of the study. "It does involve comprehensive organizational change, and part of that entails changing the behavior and habits of people working in the medical practice."
From physicians to front office staff, employees who buy into the PCMH model are more motivated to ensure a successful transformation, so how do practices make sure staff members are on board? Bleser and his fellow researchers identified 13 strategies that can be used to obtain staff buy-in to PCMH transformation. The tactics are outlined in "Strategies for Achieving Whole-Practice Engagement and Buy-in to the Patient-Centered Medical Home,"(annfammed.org) published in the January/February issue of Annals of Family Medicine.
- Authors of a study recently published in the Annals of Family Medicine sought to understand and illustrate how practices undergoing patient-centered medical home (PCMH) transformation achieved full-staff buy-in to the process.
- Researchers identified 13 strategies that can be used to obtain staff buy-in to transitioning to a PCMH.
- Strong communication, appropriate leveraging of resources and a collaborative team environment are among the keys to success.
Researchers analyzed 136 individual interviews and transcripts from seven focus groups conducted with personnel from 20 primary care practices in Pennsylvania, all of which had participated in a state-led, multipayer-supported PCMH initiative that focused on chronic care. Clinicians, medical assistants, administrators, care managers, nurses, patient educators, front office personnel and other staff members participated in the interviews. Researchers evaluated the responses to determine key strategies that promote buy-in among all members of the practice team.
The strategies fell into three domains:
- effective communication and campaigning for change,
- managing and organizing resources, and
- creating a team environment.
Getting on the Same Page
"A prerequisite of transforming, from the leadership perspective, is having all the leadership on board, in sync and putting out consistent clear communication -- what we call an internal campaign," Bleser said.
In fact, seven of the 13 strategies focused on communication. Respondents reported a desire to have access to practice leadership for support and feedback. Frequent meetings during the first year of implementation provided opportunities for education, feedback and benchmarking.
In particular, study respondents said that technical guidance to help the practice meet the goals of a PCMH was useful. For example, respondents appreciated training on how to track chronic disease in patients and conduct motivational interviewing.
Furthermore, when educating staff about the PCMH model, respondents specifically said it was useful to hear why the practice was making the transition, Bleser explained. It's important for practice leaders to highlight the benefits to the practice in terms of patient experiences, staff experiences and, if applicable, increased revenue, he noted.
Charismatic champions can help move practices toward PCMH recognition, agreed Peter Cronholm, M.D., assistant professor and director of the Mixed Methods Research Lab in the Department of Family Medicine and Community Health at the University of Pennsylvania's Perelman School of Medicine, where much of his research has focused on the PCMH. "What I've seen across multiple practices is the need to have the right people on the bus," he said.
Using Resources Effectively
In addition to PCMH cheerleaders and educators, study respondents also reported that key resources were needed to transform their health care delivery model. Leveraging resources for staffing, funding and educational support helped improve confidence and staff buy-in, interviewers found. Staff should be organized around the PCMH model, and new staff may be needed, respondents said.
The study highlighted the importance of adequate funding to achieve PCMH transformation, said Cronholm. Despite the financial benefits PCMHs may confer on payers, "right now payers are not necessarily stepping up" to support practices in their quest to make the transition, he said.
Given that the practices included in the study had received funding and technical assistance as part of the initiative, said Bleser, "It begs the question: What if you don't have access to something like that?"
Fortunately, he noted, there are other ways to piece together financial support, including obtaining grants to assist with adopting health information technology systems.
As for the learning curve associated with making the PCMH transition, networks have been established to share information and technical know-how. In Pennsylvania, the practices involved in the initiative participated in a learning collaborative, and respondents reported that the collaborative boosted their confidence in the process and helped them embrace change.
"Respondents found it valuable to talk to other practices and peers going through this process," Bleser said.
Acting as a Team
Finally, said study respondents, formal opportunities to provide input -- and acknowledgement for their ideas -- helped them feel involved in the transition process. Respondents also appreciated having clearly defined roles with enough flexibility to allow for task-sharing.
According to Cronholm, the strategies unearthed in this new study align well with his own experiences when his practice underwent PCMH transformation several years ago. Practices that foster a collaborative team approach, with plenty of positive reinforcement, tend to have an easier time with transformation, he said.
Overall, study respondents confirmed that the benefits of transforming can be substantial. "They did feel that long-term buy-in to the patient-centered medical home can be achieved," said Bleser.