1030 — Using a Mixed-Method Approach to Assess Team Member Role Transformation in PACT
Stewart GL, Solimeo SL, Paez MB, Lampman MA, Ono SS, and Rosenthal GE, VISN 23 PACT Demonstration Lab and Center for Comprehensive Access Delivery & Research (CADRE), Iowa City VA Healthcare System;
To assess how the work roles of VHA providers and staff are altered by the implementation of Patient Aligned Care Teams (PACT).
We obtained quantitative and qualitative data from members of 22 teams (96 individuals) within a Midwest VISN engaged in the implementation of PACT. A Work Roles Survey (WRS) quantitatively measured employee satisfaction, fit between roles and abilities, role clarity, role conflict, and role overload at two points in time (baseline and 1 year follow-up). Qualitative data were collected through role-based (providers, nurse care managers, clinical associates, clerical associates) focus groups at 6 and 12 months after baseline.
Compared to baseline, participants had a more negative view of their work roles one year after PACT implementation. On a 5-point scale, mean Job Satisfaction decreased from 4.0 to 3.6 (p <.05). Perceptions of the role fitting with personal abilities decreased from 3.8 to 3.4 (p <.05), and role conflict increased from 2.8 to 3.1 (p <.05). Variance in perceptions of work roles increased relative to baseline. Qualitative results obtained at approximately the same time as the second survey revealed five primary frustrations as key drivers of role difficulties: 1) working in teams that were not fully staffed, 2) needing new skills, 3) receiving inconsistent support from local leadership, 4) experiencing increased expectations to provide tailored care to a greater number of Veterans, and 5) a bottom-up implementation process that lacks specific direction about which team member should do which tasks.
PACT implementation involves more than hiring and reorganizing staff: the transition requires ongoing change within professional work roles. Despite layered and thoughtful effort to facilitate implementation, work role transition led to decreased job satisfaction in the early stages of PACT implementation.
Leaders guiding PACT implementation should be aware that providers and staff will find the implementation of medical homes difficult. The transition can be facilitated by 1) making sure teams have the necessary staff, 2) providing technical and team training, 3) having supportive and engaged local leaders, 4) clearly communicating expectations about workload, and 5) providing guidance and assistance as team members negotiate who does what within their specific teams.