The major obstacles for small practices to become involved in medical homes include, according to Nutting:
While small primary care practices may focus on schedules, they may "find it difficult to innovate" to maximize patient-centered care. Nutting says: "Most practice-level decisions are made with little input from those who see the patient experience from other perspectives."
Lack of Common Vision, Communication and Shared Experience:
While many physicians value an "autonomous practice," many rarely engage in "meaningful communication" about their overall practice vision, such as approaches to patient care, their clinical priorities, as well as individual strengths and weaknesses.
For instance, a physician may not have much of a clue how a partner may approach a patient's depression or behavioral changes, except in general terms, Nutting says.
Leadership Behaviors (Authoritative):
In their review of physician practices, Nutting says he and his colleagues continually saw physician staff members seeing their bosses as "powerful leaders" because of their training, clinical knowledge and societal role.
"We have observed many behaviors, usually unintended, that reinforce the power differential between physicians and others," Nutting wrote. Those perceptions manifest themselves throughout the offices: when the physician may not pay enough attention to having staff involved in important office discussions.
Unimaginative Roles of Mid-Level Clinicians:
Mid-level clinicians often do nearly the same work as physicians, Nutting says, but they are "clearly remaining at the lower level of the clinical hierarchy."