The PHMI Care Teams and Workforce Guide provides step-by-step guidance to help Community Health Centers and other primary care practices design, implement, and sustain high-performing, team-based primary care. It supports practices in moving from provider-centric care to core and expanded care teams organized around patients, families, and defined patient panels. The guide addresses workforce planning, staffing gaps, team composition, role clarity, task distribution, scope of practice, licensure, full-time equivalent (FTE) considerations, and working at the top of one’s license. It also explores the roles of primary care providers, nurses, medical assistants, community health workers and promotores, doulas, behavioral health specialists, pharmacists, care managers, and quality improvement and data staff.
The guide’s key activities focus on developing and testing a core care team structure, identifying and addressing staffing needs, engaging patients and families, and leveraging teams to lead continuous improvement. Additional guidance covers core and expanded care team functions, daily huddles, clinical workflows, pre-visit planning, proactive outreach, panel management, care coordination, care management, medication management, behavioral health integration, social health support, improved access, population health data analytics, and quality improvement. The guide also addresses equitable and inclusive hiring, lived experience, cultural and linguistic concordance, power sharing, shared decision-making, psychological safety, leadership and change management, workforce recruitment and retention, joy in work, burnout, virtual care, and care delivery outside traditional clinic settings.