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2015 HSR&D/QUERI National Conference Abstract

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3125 — The Role of Middle Managers in Supporting Interdisciplinary Primary Care Teams

Giannitrapani K, COIN Los Angeles; Hamilton A, COIN Los Angeles; Huynh A, COIN Los Angeles; Yano E, COIN Los Angeles; Rubenstein L, COIN Los Angeles;

Objectives:
Background: The Veterans Health Administration (VA) has implemented its version of the Patient centered medical home model called Patient Aligned Care Teams (PACT) which organizes frontline staff into "teamlets" consisting of primary care providers and registered nurses as well as clinical and administrative associates. While the teamlets are clearly interdisciplinary, supervision is not and members report to middle managers in their discipline. Objective: We sought to identify specific areas in which teamlet members perceived middle management support as critical to how teams functioned on a day-to-day basis.

Methods:
Design: Observational qualitative study; semi-structured interviews of frontline staff on VA PACT teams was collected from 2011 to 2012. Participants: 79 front line staff on VA PACT teams from 6 VA clinics in Southern California. Approach: Data coded and analyzed using team based, consensus driven, content analysis techniques.

Results:
We identified five ways that teamlet members perceive their supervising middle managers as essential to the day-to-day functioning of PACT teamlets: defining the specific roles and responsibilities of teamlet members, facilitating conflict resolution between teamlet members, setting expectations and mechanisms of accountability, facilitating within teamlet and cross teamlet coverage, and facilitating teamlet member initiated innovation. Teamlet members, further highlight challenges in each of these areas when a lack of clear middle manager involvement persists.

Implications:
Because it is the middle managers who are responsible for explaining and enforcing the specific responsibilities that front line staff assume, it is important to invest in training not only primary care team members but also their supervisors. Our expanded understanding of the role of middle managers in PACT team functioning, supports arguments for coordinated interdisciplinary leadership approaches to governing primary care practices implementing a team based model.

Impacts:
When staff working in interdisciplinary care teams report to various middle managers it is necessary to formally develop mechanisms for interdisciplinary collaboration and coordination at the middle management level.