Staffing Patterns

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Staffing patterns to improve patient care

Staffing Pattern Change Improve Patient Care

Primary care clinicians are being asked to deliver better-quality services with fewer resources. The literature has many examples of shortfalls in key physician services in primary care settings, including the delivery of preventive, chronic disease, and mental health services. The Institute of Medicine of the National Academy of Sciences, recognizing the importance of systems in the delivery of high-quality health care, has called for new emphasis on health care teams as a way to reduce medical error and improve quality of care. (Solberg, 2009) Collaborative team models have been proposed as a means to achieve a higher-quality level of clinical services. Are physicians maximizing the human resources they have in their offices by fully involving clinical staff in the delivery of preventive care? Who are the clinical staff in physician offices, what is their training, and what roles are they being asked to play?

Integrated systems of care, where physicians, nurses, and other professional and nonprofessional care-givers deliver services, have promoted the theoretical notion of greater interdisciplinary collaboration in the practice setting. At the same time, organizations such as the Medical Group Management Association have suggested optimal patient care staff-to-physician ratios for outpatient primary care practices. Their recommendations are based on surveys conducted in large group practices. However, the extent to which actual staffing patterns accommodate the diversity of practices is not well understood. Even less understood is the link between the idea of better systems of collaboration in patient care and the practical decisions that are made in determining the composition of clinical support staff. Also, assumptions about roles played by office staff underlie all staffing recommendations. Yet, competitive health care market forces may have forced many practices to seek less expensive help to provide patient care. This could result in many traditional nursing roles being performed by non-nursing patient care staff whose task training is too limited in scope to enhance and contribute flexibly to recommendations for collaborative care.

The medical and nursing literature on collaborative staffing patterns has generally focused on the integration of nurse practitioners into the delivery of primary care services. Because of their advanced practice status, we classify nurse practitioners as primary care clinicians and do not include them in our discussion of patient care staff. When we use the term “nurse” we are referring to registered nurses (RNs) and licensed practical nurses ...
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