Major Finding: Staff skepticism and resistance were mentioned 119 times during 98 semistructured interviews about obstacles to the establishment of medical homes.
Data Source: A survey of 20 clinics within 6 months of starting the transformation process.
Disclosures: Dr. Quinn had no relevant financial disclosures. The study was funded by the Commonwealth Fund and the National Institute of Diabetes and Digestive and Kidney Diseases.
SEATTLE – Although the patient-centered medical home has been touted as the future of primary care, clinic staffers may not be so sure.
Staff skepticism and resistance were the leading obstacles cited by administrators and workers who were surveyed within 6 months of starting to transform their practices (which included 20 clinics for Medicaid and uninsured patients) to medical homes, according to a study presented at the meeting.
“People are concerned that this is just a fad, just the latest thing we'll do for 2 years and nobody else will care about it and we'll stop doing it,” said one CEO respondent.
Workers wonder if it's just “another flavor of the month,” said another.
The 20 clinics are part of the Safety Net Medical Home Initiative, a 5-year transformation project headed by Quails Health with funding from the Commonwealth Fund and other sources. CEOs, medical directors, quality mangers, and others were interviewed at each clinic for 30-45 minutes. Safety Net clinics are located in Colorado, Idaho, Massachusetts, Oregon, and Pennsylvania.
“Very little research has been done about the experience of folks who are making these changes. If we can understand the process better, we can help facilitate others going through the same process,” said Michael Quinn, Ph.D., psychologist and a senior researcher at the University of Chicago and the lead investigator for the study.
Staff resistance came up 119 times during the 98 semistructured interviews; however, about as often, those surveyed said that their clinics also anticipated benefits from the medical home efforts.
Those anticipated benefits can be used to counter the doubts, Dr. Quinn said.
One clinician respondent advised looking “at real data to show how you are affecting things. Make sure [staffers] get rapid feedback to keep everything going.”
Quick-turn data are key. For example, instead of waiting months to show the staff that hemoglobin A1c levels are improving, a CEO could show the staff a reduction in no-show rates over a month or two as the clinic expands its hours into evenings and weekends.
Patient satisfaction surveys are another quick option; patients are bound to appreciate easier access and the assurance that even if they don't see their own doctor, they'll see someone on their doctor's team who is familiar with their case, Dr. Quinn commented.
If it's too early for even quick-turn data, field trips are another option that survey respondents recommended.
“[I] would have made a point to take more staff to see a clinic that's doing it right earlier. We did a few weeks ago, and it changed attitudes of staff and increased buy-in,” one CEO responded.
It's also important to let skeptics know that as part of a medical home, they can expect to work in a more-supportive environment and to make fuller use of their license, Dr. Quinn said.
“Nurses are excited about the opportunity to work at the top of their license, getting to work to their fullest potential, which makes them happy,” one medical director noted.
As with any change, it's important to include everybody in the decision making as much as possible, regardless of their position in the office hierarchy.
“No directives from above; that's been the best thing we've ever learned. [Get] buy-in from the bottom up, and [get] people to understand why we're doing things,” said one CEO.
With such approaches, “everybody can really catch some of the excitement about” becoming a medical home, Dr. Quinn said.
This approach has worked in at least one clinic. “Even reception is buying into the idea that they're part of an organization, not just here for a job. People don't mind staying as late; they know the patient needs it,” a provider there said.
In the survey, limited staffing, inadequate electronic medical record systems, and insufficient financial support were also cited as medical home obstacles, but far less often than were staff skepticism and resistance.