Annals of Family Medicine Research

Clerical Staff Serve Critical Role on Patient-Centered Care Team

August 31, 2016 09:36 am Sheri Porter

Every member of the patient-centered medical home (PCMH) care team is important -- even those with clerical tasks, said authors of research published in the July/August Annals of Family Medicine.

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To meet the demands of today's rapidly changing care delivery landscape, health care organizations would do well to invest in resources to bring primary care clerks onboard as skilled health care team members, said researchers in an article(www.annfammed.org) titled "The Critical Role of Clerks in the Patient-Centered Medical Home."

"In moving to high-value delivery strategies, health care organizations are challenged to provide care that is both efficient and patient-centered," said the authors. "We believe that an important but underappreciated strategy for health systems to meet these challenges is to better leverage the role of clerks."

Clerks, Veterans Affairs and PCMH

Corresponding author Samantha Solimeo, Ph.D., M.P.H., serves as an assistant professor of internal medicine at the University of Iowa Carver College of Medicine in Iowa City. She's also an investigator for the Center for Comprehensive Access and Delivery Research and Evaluation at the Iowa City Veterans Affairs (VA) Heath Care System.

Story Highlights
  • New research from Annals of Family Medicine shows that all members of the care team play a critical role in delivering efficient, patient-centered care.
  • Research based on the Department of Veterans Affairs patient-centered medical home model shows that primary care clerks contribute to quality improvement, care coordination and team function.
  • Authors noted that clerks are friendly faces who build relationships with patients and engender patient trust and satisfaction.

Solimeo told AAFP News that her research group at the VA Midwest Health Care Network Patient-Aligned Care Team Demonstration Lab was established in 2010 to study team development and function as part of the national implementation of the VA's PCMH model of care.

That work was supported by the VA Office of Patient Care Services.

"Our study of clerical associates' roles within patient-aligned care teams was a natural outcome of our attention to team development," said Solimeo. She noted that in the VA, care teams comprise four players: a primary care provider, a nurse care manager, a clinical associate and a clerical associate.

Solimeo answered a few specific questions about the research and what it means to family physicians.

Q. Were there any surprises as your team developed its research findings?

A. When we embarked on this research, I think we (the team) had internalized the view that the clerical staff were there largely to assist clinically trained staff who were performing the "real" work of patient care. The ethnographic approach we used -- integrating in-person field observations with focused interviewing and analysis of Patient-Aligned Care Team documents such as training materials and team reports -- essentially opened our eyes to the kinds of care provided to primary care patients by clerks. We also discovered clerks' contributions to quality improvement, care coordination and team function.

Q. Why should this topic be of interest to family physicians?

A. The PCMH model redesigns the ways by which primary care providers engage health information, panel management and quality improvement, and in doing so, compels providers to significantly invest in the human capital of an interprofessional team.

Optimizing the professionalism of clerical staff may reduce the workload of clinically trained staff, as well as enhance the long-term relationship between patients and the clinic.

Q. What's the single most important point you want family physicians to take away from your research?

A. Care is not isolated to the clinical encounter -- it begins with the first contact between a patient and the team. Clerks are patients' first introduction to the quality of care they will receive from their PCMH.

Q. What should health care systems in general, and family physicians in particular, do with this information?

A. Invest in human capital to reduce the utilization of clerks as interchangeable workers. In doing so, the PCMH can leverage clerks' labor to reduce workload for clinically trained staff, as well as invest in the long-term institutional and patient knowledge that signify clerks' unique contributions to care.

Q. Where should the research go next?

A. There are few data on the breadth of PCMH clerical expertise. We should examine the unique skill sets required of clerks working in specialty PCMH environments (e.g., pediatric, geriatric or women's health) so that we may maximize their contributions to care.

Implementing These Strategies

Solimeo and her research colleagues identified three specific strategies to help family physicians and their health care organizations enhance the contribution of clerks to the PCMH team.

Examine the definition of high-quality primary care. The kind of care expected from a PCMH setting depends on patient interactions with all staff members -- including nonclinical team members -- throughout a health care organization.

"Recognizing the opportunities to enhance patient-centered care enveloped within clerical work could help combat patients' perceptions of health care organizations as anonymous institutions," noted the authors. Clerks are "friendly faces" who build relationships with patients and their families and "engender patient trust and satisfaction," they added.

Understand the contribution clerks make to the overall goal of providing individually tailored patient-centered care. "The benefits afforded by presumed efficiencies in centralized scheduling, for example, should be carefully weighed against potential losses in the quality of tailored care," wrote the authors.

"When clerks answer the telephone or greet patients in a waiting room, they have an opportunity to establish rapport with individual patients and initiate a pathway that ensures that patients' preferences and needs are addressed by a health care team with unique roles and capacities," they added.

Look beyond short-term costs to potential long-term savings. The authors recognized the costs involved in not only increasing the number of clerical workers but in investing in the necessary training for those workers expected to engage in care coordination, "including an emphasis on proactively responding to patient needs and personalizing care delivery."

However, those costs potentially could be offset by "reduced turnover, less employee burnout and fewer inefficiencies arising from unstable teams," said the authors.

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