How middle managers facilitate interdisciplinary primary care team functioning.

Area of Science:

• Health Services Research
• Organizational Management
• Primary Care Delivery

Background:

• The Veterans Health Administration (VA) organizes primary care using a Patient-Centered Medical Home (PCMH) model.
• Interdisciplinary 'teamlets' manage patient panels, but members may report to separate middle managers.
• The role of middle managers in PCMH implementation is not well understood.

Purpose of the Study:

• To examine frontline interdisciplinary staff perceptions of middle managers' roles.
• To characterize middle managers' impact on primary care operations and teamlet functioning.
• To understand middle management's influence within the VA's PCMH model.

Main Methods:

• Qualitative study using semi-structured interviews.
• Involved 79 frontline interdisciplinary staff from VA Patient Aligned Care Teams (PACT) teamlets.
• Interview data analyzed using constant comparison.

Main Results:

• Staff view middle managers as essential for clarifying roles, setting expectations, and resolving conflicts.
• Middle managers facilitate teamlet-initiated innovation and provide coverage strategies.
• Lack of middle manager involvement led to identified challenges.

Conclusions:

• Frontline staff perceive a continued need for discipline-specific middle management leadership.
• Middle managers are crucial for interdisciplinary problem-solving, scheduling, and fostering innovation.
• There is a need for enhanced structure and training for middle managers in PCMH models.