TY - JOUR
T1 - Examining Role Change in Primary Care Practice
AU - Isaacson, Nicole
AU - Holtrop, Jodi Summers
AU - Cohen, Deborah
AU - Ferrer, Robert L.
AU - Mckee, M. Diane
N1 - Funding Information:
We identified several factors that can facilitate role change in primary care practice. Success in taking on a new role may be enhanced when the following conditions are met: there is patient demand for services provided via the new role, occupants of the new role have the structural autonomy to take on new responsibilities and behave in new ways, and the new role has cultural credibility and institutional support in the practice setting. In the interventions we examined, projects with greater flexibility to hire people in new roles faced fewer barriers mobilizing role occupants than the project relying primarily on the skills, background, and training of existing practice staff. For project 3, strong institutional support at the administrative and practice leader level was not enough to overcome lack of client demand, limited credibility within the practice culture for the role change, and difficulty mobilizing the MAs to embrace their new role responsibilities. In addition, clinicians who did not support their MAs in the new role may have eroded MAs’ confidence and impaired successful role change. Project 3 conceptualized the MA role change as a simple and low-intensity intervention; however, MAs did not experience it this way. In contrast, projects 1 and 2 had role occupants with higher skill levels and cultural credibility within the practice; nonetheless, when patient demand was low and institutional support limited, even these staff found it more difficult to effectively provide health behavior change counseling. These findings suggest that if existing staff are asked to assume new roles, leadership should carefully consider what background is sufficient, what training is needed, what old responsibilities could be removed, and how support in the environment can be optimized. Significant change in one role on a team is also likely to stress other team members, making change difficult to implement and sustain without investment in professional development and support for other team members. Thus, adequate resources, including adequate financial reimbursement, to support integration of new responsibilities are also necessary. 7 , 27 This research is limited in several ways. We have a small sample of 3 projects; however, these projects included 27 primary care practices that are reflective of many typical practice settings. Because there are no direct data from patients, information about patient demand for services is inferred from diary and interview data. Another limitation is that these interventions were implemented as research studies, which could have reduced practices’ investment in the outcomes. Last, there may be other explanations for the success or failure of the role transitions described that were not brought forth for examination. While this study has limitations, these limitations are outweighed by the novel contribution this research makes to an important, highly relevant, and understudied area of primary care research that identifies factors that influence role change in the primary care setting. This study illustrates how role change theory is one theory that may inform future practice redesign efforts. Adding preventive and chronic care services such as health behavior change counseling often requires highly skilled roles and adequate financial resources, as well as structural autonomy for skilled practitioners to deliver these services. Regardless of the decision to either expand the roles of existing staff or to hire new staff careful attention to the 5 factors examined here may facilitate improved role transition in either case. Understanding how these conditions affect role change in primary care practice is important for planning and redesigning primary care delivery systems to provide health behavior services. Although this study did not specifically examine teamwork—how the people in the new roles worked together (or not) with other members of the clinics—understanding the elements needed to facilitate role adoption in practice is an important step in furthering efforts toward practice transformation to new models of team-based care. The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the Prescription for Health (P4H) program funded by the Robert Wood Johnson Foundation (RWJF; grant 053221) in collaboration with the Agency for Healthcare Research and Quality (AHRQ). The authors report no conflicts ofinterest.
PY - 2012/7
Y1 - 2012/7
N2 - Purpose: While experts suggest that primary care needs far-reaching transformation that includes adding or reconfiguring roles to improve patient care, little is known about how role change occurs in practice settings. Methods This was a cross-case comparative analysis of 3 projects designed to improve health behavior counseling in primary care practices by adding to or changing clinical support staff roles. Qualitative data (site visits notes, grantee reports, interviews with grantees, and online diary entries) were analyzed to examine instances of role change in depth, using role change theory as an organizing framework. Results Practice team members had greater success taking on new roles when patients valued the services provided. Often, it was easier to a hire a new person into a new role rather than have an existing practice member shift responsibilities. This was because new personnel had the structural autonomy, credibility, and organizational support needed to develop new responsibilities and routines. Conclusion: As primary care delivery systems are redesigned in ways that rely on new roles to deliver care, understanding how to effectively add or change staff roles is essential and requires attention to patients’, practice members’, and institutions’ support for new roles.
AB - Purpose: While experts suggest that primary care needs far-reaching transformation that includes adding or reconfiguring roles to improve patient care, little is known about how role change occurs in practice settings. Methods This was a cross-case comparative analysis of 3 projects designed to improve health behavior counseling in primary care practices by adding to or changing clinical support staff roles. Qualitative data (site visits notes, grantee reports, interviews with grantees, and online diary entries) were analyzed to examine instances of role change in depth, using role change theory as an organizing framework. Results Practice team members had greater success taking on new roles when patients valued the services provided. Often, it was easier to a hire a new person into a new role rather than have an existing practice member shift responsibilities. This was because new personnel had the structural autonomy, credibility, and organizational support needed to develop new responsibilities and routines. Conclusion: As primary care delivery systems are redesigned in ways that rely on new roles to deliver care, understanding how to effectively add or change staff roles is essential and requires attention to patients’, practice members’, and institutions’ support for new roles.
KW - health behavior change
KW - primary care practice teams
KW - role change
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U2 - 10.1177/2150131911428338
DO - 10.1177/2150131911428338
M3 - Article
AN - SCOPUS:84990403742
SN - 2150-1319
VL - 3
SP - 195
EP - 200
JO - Journal of primary care & community health
JF - Journal of primary care & community health
IS - 3
ER -
