Table 3.

Facilitators to MA Role Shifts

FacilitatorsSample Quotations
Explanation of how new MA responsibilities fit within the broader PCMH practice transformation goals[The MA] reiterated that she thinks [Doctor], [Office Manager], and [Population Care Coordinator] do a really good job of explaining exactly what they want for the QI projects. She said the staff generally takes orders well, but that it's easier when they understand and appreciate the goals of the project and get good instructions …She has a pretty robust understanding of PCMH, about care coordination, about the importance of patients getting the disease follow-up and preventive care that they need, and about why they collect so much data. (fieldnote, Practice 12)
Extra training[The PCC] tells me that the MAs feel uncomfortable talking to a patient about the patient's weight (or smoking) when they themselves (the MAs) are overweight and/or smoke…. [She] is coaching the MAs on how to approach difficult topics with a patient…. [The office manager] also has mentioned this coaching as one of the things she believes [PCC] excels in doing, and that she has noticed a difference in how the MAs are working with patients. (fieldnote, Practice 9)
Detailed protocols and standing ordersThey have standing orders for chronic disease management as well, so, for example, they have standing orders for diabetic labs. They use a screening questionnaire before administering vaccines too. For diabetic retinal screenings, they have a form they use to get the eye doctor to send back the results. (fieldnote, Practice 13)
Open communicationThe first way to make sure that staff buy-in happens is communication, communication, communication…we allow the staff to ask questions, or to question why we're saying we should do things this way, because no one truly understands unless they see the big picture. So the staff doesn't feel that this is what I do because I have to do it. Hopefully, they understand the process and the reason why they're doing what they're doing. (Office Manager interview, Practice 5)
Initial small and achievable goals[The MA] said they had decided to start with the smaller goals first and after that to work on the bigger goals. Medication reconciliation was a small goal, whereas screenings will be a bigger goal. Another bigger goal is to have less patients running to the emergency room, which she says they can work on by encouraging better control and compliance. She gave the example of making sure CHF patients take their water pills every day by instructing them on the importance of doing this. (fieldnote, Practice 6)
Compensation for extra effortsThey have a new feedback system that goes along with the bonuses for doctors and staff, part of which [the lead physician] bases on their engagement with the PCMH and QI initiatives currently underway…. Everybody accepts the system and understands why they are doing the projects that they are doing, and what role they each play in the overall plans. (fieldnote, Practice 12)
  • MA, medical assistant; QI, quality improvement; PCC, population care coordinator; PCMH, patient-centered medical home.