“It goes beyond good camaraderie”: A qualitative study of the process of becoming an interprofessional healthcare “teamlet”

ABSTRACT

Within the US, the patient-centred medical home has become a predominant model in the delivery of primary care. This model requires a shift from the physician-centric model to an interprofessional team-based approach. Thus, healthcare staff are being reorganized into teams, resulting in having to work and relate to one another in new ways. In 2010, the Veterans Health Administration implemented the patient aligned care team (PACT) model, its version of the patient-centred medical home. The transition to the PACT model involved restructuring primary care staff into “teamlets”, consisting of a registered nurse, licensed practical nurse, and administrative clerk for each full-time-equivalent primary care provider. This qualitative study used observation and semi-structured interviews to understand the factors that affect teamlet functioning as they implement this new model of care and how teams are interacting to address those factors. Findings suggest that role understanding includes understanding how each teamlet member’s tasks are performed in the daily operations of the clinic. In addition, willingness to perform tasks that benefit the teamlet and acceptance of delegation from all teamlet members were found to be important for teamlet functioning and cohesion. In order for healthcare teams to provide patient-centred care, it is important to provide guidance and support about what these new relationships and roles will entail. The building of team relationships is not a static process; ways of working together build over time and, therefore, should be seen as a continuous cycle of quality improvement.

KEYWORDS:

• Case study
• coaching
• interprofessional team
• patient-centred practice
• primary care
• qualitative method

Acknowledgements

The authors would like to thank Ann Annis, Eve Kerr, Sarah Krein, and Darcy Saffar. The authors would like to offer a very special thanks to the Primary Care staff who shared their time, thoughts, and experiences with them.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Funding

This study was conducted by the VAAAHS PACT Demonstration Laboratory and funded by the VA Office of Patient Care Services. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

Additional information

Funding

This study was conducted by the VAAAHS PACT Demonstration Laboratory and funded by the VA Office of Patient Care Services. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.