Redesigning primary care in the safety net: A qualitative analysis of team-based care implementation.

BACKGROUND: Team-based care is an innovative approach to primary care in which groups of health care professionals work collaboratively to manage care for groups of patients. Safety-net organizations face specific barriers to implementing health care innovations. More research is needed that documents the dynamics that inform implementation and sustainment of innovative practices in the safety net.

METHODS: We conducted qualitative fieldwork, including purposeful observation and semi-structured and informal interviews, to explore the implementation of care teams in safety-net clinics in California. Field notes and transcripts were analyzed using an inductive approach to identify overarching themes across sites.

RESULTS: Salient themes across clinics suggest that 1) well-designed physical layouts that promote sustained patterns of structured and spontaneous communication and collaboration are critical to creating high-functioning teams; 2) implementation of team-based care relies on a relaxing of the traditional clinic hierarchy into an agile organizational structure that empowers all clinic staff-most notably medical assistants-by facilitating an ethos of collaborative decision-making, interdependence, and shared responsibility; and 3) resource constraints related to recruitment and retention of qualified staff are key barriers to implementation.

CONCLUSIONS: Team-based care has the potential to improve patient outcomes, strengthen relationships and well-being among clinic staff, and expand staff roles to facilitate collective accomplishment of work goals. To successfully launch and sustain care teams in safety-net clinics, greater commitments to creating well-designed spaces and a re-envisioning of the training and compensation for medical assistants that reflects the valuable role these individuals can play appear to be necessary.