Roles of Office and Clinic Staff

Front desk and administrative staff members perform many roles in the medical home. In addition to serving as the friendly face and voice of the office, they also can organize and manage systems that support patient care. Their skill at being personable and involved can put patients at ease for their Texas Health Steps preventive medical checkup, follow-up visit or acute care visit.

Online and automated appointment scheduling frees front desk/administrative staff to contribute more fully in delivering health care, which can increase job gratification and patient satisfaction. These workers can:

• Develop proficiency managing the forms, equipment, documentation, follow-up and referral procedures involved in patient appointments.
• Coordinate pre-visit planning with the clinical team.
• Before appointments, remind patients to bring all items needed for exams and checkups.
• Provide instructions for any telemedicine appointments ahead of time.
• Before the patient arrives, distribute digital questionnaires and forms for health histories and screenings.
• Before the patient leaves, schedule the next checkup or follow-up visit, if appropriate, and set automatic reminders.

Rather than working in a “silo” separate from the provider and other medical home staff, medical assistants, nurses and other clinical staff are in a position to expand their roles to focus on patient health outcomes. They are vital team members who can help patients work toward meeting their care plan goal.

“The roles of medical assistants and nurses are expanding” in medical homes (O’Malley, Gourevitch, Bond, & Tirodkar, 2015). Incremental delegation of non-clinical tasks away from physicians and template-guided information collection from patients before medical appointments can be key improvements in patient-centered medical homes (Ibid.). For example, a busy medical practice can develop protocols and templates based on specific patient complaints and chronic conditions, and these guides can direct the questions asked of patients and families by clinical staff when gathering health information. Standardized text about conditions and symptoms that often come up can be dropped into the notes.

According to an American Academy of Family Physicians’ article (Family Practice Management, 2014):

The majority of patient appointments can be divided into four distinct stages:

1. Gathering data
2. Physical examination and synthesis of data
3. Medical decision-making
4. Patient education and plan-of-care implementation

“In a traditional practice model, the physician is solely responsible for most, if not all, of these four stages. With a ‘team care’ model, however, the physician and clinical assistant share these responsibilities” (Ibid.).

Nurses and other clinical staff can:

• Handle much of the data gathering
• Take and record vital signs
• Measure and document growth parameters
• Complete health screenings
• Administer immunizations
• Complete treatments and medical procedures as directed by the physician
• Document symptom complaints and other patient health concerns
• Seek additional details through questioning
• Review and update medical, surgical, social and family histories
• Review upcoming or overdue health maintenance topics and pending orders for tests or procedures
• Review patient’s medication list and upcoming refills
• Provide health education and anticipatory guidance
• Help patient obtain external resources to assist in care management

Nurses can also “perform a triage assessment of the daily calls (from ill or perplexed patients or families) that improves access of care” (AAFP, 2014). Nurse care managers can be key team members, specifically by developing care plans in partnership with the primary care provider as well as by working with patients between appointments to help them manage chronic health conditions (O’Malley et al., 2015).

In addition, it is not unusual for patients and families to develop a bond with front desk staff or clinical staff, viewing them as advocates who can answer questions or help solve a problem.

As part of a medical home team, the provider establishes a culture and organizational flow that promotes unity among staff in service to patients and their families.

The provider can inspire a medical home team to perform at its highest level, as appropriate for the licensure and abilities of each staff member.

Before the provider enters the exam room, the front desk staff and clinical staff have gathered key health information about the patient. Those tasks free up time for the provider to concentrate on:

• Listening to the patient
• Conducting the physical exam
• Providing Texas Health Steps anticipatory guidance based on exam results and concerns expressed by the patient and parent
• Developing a treatment plan with the patient
• Helping the patient set health goals and next steps

Having an assistant in the exam room supporting the provider completing the Texas Health Steps preventive medical checkup can save time for the provider and allow more time to concentrate on the patient.

In a patient-centered medical home, the provider adopts evidence-based guidelines and monitors their use to ensure quality control. Training and feedback are key to team competency in a patient-centered medical home. Workflow problems must be discussed and addressed as a team to keep the medical home running effectively and efficiently.