ADVERTISEMENT

The Group Practice Manager in the VHA: A View From the Field

The Veterans Health Administration implemented the group practice manager position at 5 diverse prototype sites to improve clinical practice management and increase access to care.
Federal Practitioner. 2020 February;37(2)a:79-85
January 31, 2020|Federal Practitioner
Cynthia LeRouge, PhD;Savitha Sangameswaran, MS;Bianca Frogner, PhD;Cyndy Snyder, PhD;Lisa Rubenstein, MD;Susan Kirsh, MD, MPH;George Sayre, PsyD
Author and Disclosure Information

Cynthia LeRouge is an Associate Professor in the Department of Information Systems and Business Analytics at Florida International University in Miami. Savitha Sangameswaran is a Doctoral Student at the Department of Biomedical Informatics and Medical Education; Bianca Frogner is an Associate Professor, Director for the Center for Health Workforce Studies, and Deputy Director of the Primary Care Innovation Lab; and Cyndy Snyder is an Affiliate Assistant Professor, all at the University of Washington School of Medicine in Seattle. Lisa Rubenstein is Professor Emeritus at the University of California Los Angeles Schools of Medicine and Public Health and a Senior Scientist at the RAND Corporation. Susan Kirsh is the Acting Assistant Deputy Undersecretary for Access to Care at the Veterans Health Administration. George Sayre is a Health Services Researcher at the VA Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care and Clinical Assistant Professor in the Department of Health Services at the University of Washington.
Correspondence: George Sayre (george.sayre@va.gov)

Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.

Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies.

GPM knowledge, skills, and abilities. GPMs presented a complex range of knowledge, skills, and abilities, including clinical, administrative, analytics, and people skills. All interviewees reported that their prior education and experience did not sufficiently train them for the GPM role. GPMs identified a willingness to learn quickly as a critical characteristic. Many GPMs tended to have a formal education in health administration or business (eg, MBAs); others had administrative experience (eg, administrative assistance to executive leadership) or clinical training (eg, physician assistant). Detailed clinical knowledge was not expected, but clinical familiarity was helpful.

Some interviewees also mentioned previous experience and familiarity with the VHA system specifically as an advantage. This was especially true for VA outpatient flows, clinic flows, and understanding what an outpatient is in a VA context. Interviewees noted the importance of GPMs needing to be able to analyze patient demand metrics and underlying data in order to determine supply of providers and then to allocate adequate resources to complement providers. Forecasting skills were referenced as a key point. “They need to be able to be assured that they can recruit more providers if needed,” a national support staff advisor noted.

Given the importance of developing effective relationships, communication skills were mentioned by most participants and underscored as critical to establishing trust between GPMs and others as the initiative was being implemented. Interviewees indicated that relationship building was further enhanced when GPMs possessed the ability to “work with” rather than command clinicians and staff; navigate politics; and were respectful of other people’s knowledge, skills, abilities, and status. “They have to work with the nursing staff and teach them,” a leader described, “so that people understand that we are going to a different place to achieve our primary objectives and goals.”

 

Issues and Challenges

Participants identified several technical, social, and structural challenges and barriers to successfully implementing the GPM role.

Technical challenges. Recurring themes across all phases of data analytics were GPMs’ capability to challenge data use and use large volumes of information from multiple data sources (entering and accessing data; “drilling down” from summaries; generating reports; and analyzing and interpreting resulting metrics). Interviewees reported that information assessment and analytic support were not consistent. One GPM had a data analyst pulling reports needed to support clinical units while other GPMs trained staff to pull data. Even with support, some GPMs had issues due to limited information technology (IT) skills or access privileges leading to inefficiencies and delays. “Whenever I need anything from a programmer, I have to go through, you know, the IT gods in the sky,” one GPM remarked. “That usually takes a few months or more.”

Social challenges. Instituting the GPM role was a cultural change, and interviewees reported needing to address resistance to CPM model efforts. Resistance to change “is particularly hard in the VA just because it has a unique culture,” one leader noted. “There is a comfort in the legacy way of doing things.” The GPM initiative was introduced during a time when other national level initiatives were being implemented throughout the VHA. Fulfilling requests for information for these initiatives became the responsibility of the GPM and their team, which diverted attention from the mandate to improve access. Furthermore, GPMs were often considered the “change communicators” to clinics putting them in the role of “bad messenger,” which degraded trust and made it difficult to partner with clinicians.

ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT