This project includes an intervention in five Michigan Medicine family medicine clinics which is designed to improve staff collaboration across different job roles.

The primary intervention asks staff to meet with others in the same role and to consider the following questions:

• The Ask: When staff are busy or overwhelmed by work, what tasks can others do (people in each of these groups) to help make your job better or easier?
• The Offer: When people in other groups are busy or overwhelmed, what tasks can your group do to help make staff jobs better or easier?

After this information is collected, at an in-person meeting of all staff and faculty, the study team will divide everyone into groups by clinic and then by the four roles. The study team will hand out the idea list and ask participants to review the list, discuss whether there are new or additional ideas which should be added, and then prioritize staffs top five "asks" and top five "offers" for staff role.

Negotiation of asks/offers: The study team will hold 1-4 subsequent brief meetings at each clinic where staff are again sub-divided into four groups by role. Each group will review the asks from people in other roles and decide whether these are actions that staff can help with or whether there are barriers. The clinic champions will work with the groups to address barriers (which could include lack of information, lack of training, disagreements about need, etc). The ultimate goal will be for groups to come to consensus agreement on at least three ways staff can assist people in other roles. In some clinics this may be straightforward and require just one meeting. In other clinics, it may take several meetings.

Implementation: Once the asks and offers are finalized, it will be up to the physician champions to help promote these agreements at the clinic, follow up with staff and with the nursing, medical assistants, and clerical champions to ensure that people are following thru with commitments to help, and trouble shoot problems that come up.

Coordination with Leadership: a department leader will serve as the liaison between the clinic champions and members of leadership that oversee clinical functions. This leader meets regularly with these leadership groups and will help troubleshoot challenges to implementing the asks and offers which need higher-level approval or input.

Ongoing process improvement: Over time, the study team will send up to four brief, anonymous surveys to all staff asking whether the staff are indeed doing the things that staff committed to do and whether other role groups are following thru on the commitments. This provides an opportunity for people to identify and report problems. This data will be anonymously fed back to the physician champion that is tasked to troubleshoot and address the problems identified, working with the liaison as appropriate. This will likely require continuous process improvement and revisiting to ensure success.

Evaluation: The study team proposes to measure burnout and team centeredness using anonymous on-line surveys.

Brief surveys: At several points during the year, the investigators will send out brief surveys. These ask for the clinic and job role and then ask participant to rate how much effort they have made to help others, how much effort others have made to help them, and if there are open-ended comment about what is or is not working. This information will be used to improve the intervention at each clinic.

Qualitative interviews regarding clinic culture will also be conducted with the project champions at each clinic who are helping to implement the project.

This study is Institutional review board (IRB) exempt and will have a waiver of documentation of informed consent with survey completion representing consent.

Inclusion Criteria:

• Staff in the roles of medical assistant, nurse, clerical staff, or clinician (physician, nurse practitioner, and physician assistant)
• Must work in one of five family medicine clinics at the University of Michigan.

Exclusion Criteria:

• administrative clinic director at each site (managerial)
• Staff outside of the above roles such as a dietician, social worker, pharmacist