Abstract
BackgroundPrimary care staffing decisions are often made unsystematically, potentially leading to increased costs, dissatisfaction, turnover, and reduced quality of care. This article aims to (1) catalogue the domain of primary care tasks, (2) explore the complexity associated with these tasks, and (3) examine how tasks performed by different job titles differ in function and complexity, using Functional Job Analysis to develop a new tool for making evidence-based staffing decisions.MethodsSeventy-seven primary care personnel from six US Department of Veterans Affairs (VA) Medical Centers, representing six job titles, participated in two-day focus groups to generate 243 unique task statements describing the content of VA primary care. Certified job analysts rated tasks on ten dimensions representing task complexity, skills, autonomy, and error consequence. Two hundred and twenty-four primary care personnel from the same clinics then completed a survey indicating whether they performed each task. Tasks were catalogued using an adaptation of an existing classification scheme; complexity differences were tested via analysis of variance.ResultsObjective one: Task statements were categorized into four functions: service delivery (65%), administrative duties (15%), logistic support (9%), and workforce management (11%). Objective two: Consistent with expectations, 80% of tasks received ratings at or below the mid-scale value on all ten scales. Objective three: Service delivery and workforce management tasks received higher ratings on eight of ten scales (multiple functional complexity dimensions, autonomy, human error consequence) than administrative and logistic support tasks. Similarly, tasks performed by more highly trained job titles received higher ratings on six of ten scales than tasks performed by lower trained job titles. Contrary to expectations, the distribution of tasks across functions did not significantly vary by job title.ConclusionPrimary care personnel are not being utilized to the extent of their training; most personnel perform many tasks that could reasonably be performed by personnel with less training. Primary care clinics should use evidence-based information to optimize job-person fit, adjusting clinic staff mix and allocation of work across staff to enhance efficiency and effectiveness.
Highlights
Primary care staffing decisions are often made unsystematically, potentially leading to increased costs, dissatisfaction, turnover, and reduced quality of care
Six Veterans Affairs (VA) medical centers participated in the study, based on the following criteria identified by an expert advisory panel as likely to influence staffing patterns and the work conducted in primary care: medical school affiliation, size, past history as primarily a psychiatric inpatient unit, and the implementation of advanced clinic access in primary care
To test the assumption that the distribution of work among primary care personnel varied across facilities, we calculated the number of sites endorsing a given task statement, grouped by job title
Summary
Primary care staffing decisions are often made unsystematically, potentially leading to increased costs, dissatisfaction, turnover, and reduced quality of care. Without a suitable evidence base to support them, are counterproductive in two important ways They may utilize more highly trained, more expensive personnel for administrative or simple tasks that could be performed by less expensive personnel. They may require significant staff time for tasks below the full use of employees' skills and training. Increased turnover for similar reasons has been noted among other primary care staff, both clinical and administrative [5]. Staffing decisions directly affect quality of care: new models of care and evidence-based practice (e.g., chronic care model, clinical practice guidelines) often require changes in staffing levels, configurations [12], and coordination patterns [13] to produce successful, sustainable improvements
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