Activities and Sensemaking Associated With Frontline Role Expansion in Primary Care Settings

Many healthcare settings are embracing a dynamic of role expansion across occupational boundaries. This dynamic is particularly evident in organizations that are early adopters of innovations designed to improve care delivery. This study explores role expansion of frontline healthcare workers in primary care settings associated with early adoption of the patient-centered medical home. Qualitative data in the form of interviews were collected from 2012 to 2014 from six primary care practices functioning as early adopters of patient-centered medical homes. Fifty-one staff members were interviewed across the six practices. The author identified three forms of role expansion among frontline workers in these primary care practices. This role expansion was accompanied by key instances of work improvisation and enhanced social connections among staff and patients that fed into particular forms of sensemaking. Transformation of primary care delivery may be enhanced through expansion of frontline workers' roles, particularly at the early adoption phase.