A quantitative assessment of the parameters of the role of receptionists in modern primary care using the work design framework.

BACKGROUND: Amidst increased pressures on General Practice across England, the receptionist continues to fulfil key administrative and clinically related tasks. The need for more robust support for these key personnel to ensure they stay focussed and motivated is apparent, however, to be effective a more systematic understanding of the parameters of their work is required. Here we present a valuable insight into the tasks they fulfil, their relationship with colleagues and their organisation and their attitudes and behaviour at work collectively defined as their 'work design'. METHODS: Our aim was to quantitatively assess the various characteristics of receptionists in primary care in England using the validated Work Design Questionnaire (WDQ) a 21 point validated questionnaire, divided into four categories: task, knowledge and social characteristics and work context with a series of sub-categories within each, disseminated online and as a postal questionnaire to 100 practices nationally. RESULTS: Seventy participants completed the WDQ, 54 online and 16 using the postal questionnaire with the response rate for the latter being 3.1%. The WDQ suggested receptionists experience high levels of task variety, task significance and of information processing and knowledge demands, confirming the high cognitive load placed on receptionists by performing numerous yet significant tasks. Perhaps in relation to these substantial responsibilities a reliance on colleagues for support and feedback to help negotiate this workload was reported. CONCLUSION: The evidence of our survey suggests that the role of modern GP receptionists requires an array of skills to accommodate various administrative, communicative, problem solving, and decision-making duties. There are ways in which the role might be better supported for example devising ways to separate complex tasks to avoid the errors involved with high cognitive load, providing informal feedback, and perhaps most importantly developing training programmes.

' but I just prefer to treat everyone the same ': general practice receptionists talking about health inequities.

General practice receptionists are positioned at the beginning of a patient's journey within the healthcare system, yet their influence on a patient's experience is unknown. The limited data on, and research involving, general practice receptionists both in New Zealand and internationally is evidence of this. This research undertook an exploration of the discourses used by a group of general practice receptionists in Wellington, New Zealand to discover how they talk about, and represent, health inequities. Eight in-depth semi-structured interviews were conducted, guided by Social Constructionism and Decolonising Theory. Three reoccurring patterns of discourse were identified: discourses about the social determinants of health; discourses about Maori culture and behaviour; and discourses about egalitarianism. Further, narratives that could be seen as deficit-focussed or victim-blaming were identified. Racism was not directly discussed by participants as a health determinant. The findings support the need for training guided by cultural safety and anti-racism principles to be available for all general practice receptionists.

Monthly communication skill coaching for healthcare staff.

OBJECTIVE: To promote monthly interpersonal skill communication role-play and coaching for front-office staff. METHOD: For 15 min a month, during staff meetings, healthcare staff such as receptionists and medical assistants should participate in communication skill coaching. Participants should discuss a recurring communication challenge (e.g., patients irritated by repeated requests for health histories), role-play options for communication, and receive feedback. RESULT: Interpersonal communication skills such as acknowledging the concerns of others are acquired slowly. Repeated practice and supportive feedback increase the likelihood that these skills will be valued and mastered. CONCLUSION: Research shows communication skills develop when they are modeled and role-played frequently and are less likely to develop with occasional interventions. PRACTICE IMPLICATION: Health care professionals should devote time to role-playing interaction with patients for brief intervals at least monthly. Staff should give one another feedback on the best options for managing challenging communication situations.

Between demarcation and discretion: The medical-administrative boundary as a locus of safety in high-volume organisational routines.

Patient safety is an increasing concern for health systems internationally. The majority of administrative work in UK general practice takes place in the context of organisational routines such as repeat prescribing and test results handling, where high workloads and increased clinician dependency on administrative staff have been identified as an emerging safety issue. Despite this trend, most research to date has focused on the redistribution of the clinical workload between doctors, nurses and allied health professionals within individual care settings. Drawing on Strauss's negotiated order perspective, we examine ethnographically the achievement of safety across the medical-administrative boundary in key high-volume routines in UK general practice. We focus on two main issues. First, GPs engaged in strategies of demarcation by defining receptionist work as routine, unspecialised and dependent upon GP clinical knowledge and oversight as the safety net to deal with complexity and risk. Receptionists consented to this 'social closure' when describing their role, thus reinforcing the underlying inter-occupational relationship of medical domination. Second, in everyday practice, GPs and receptionists engaged in informal boundary-blurring to safely accommodate the complexity of everyday high-volume routine work. This comprised additional informal discretionary spaces for receptionist decision-making and action that went beyond the routine safety work formally assigned to them. New restratified intra-occupational hierarchies were also being created between receptionists based on the complexity of the safety work that they were authorised to do at practice level, with specialised roles constituting a new form of administrative 'professional project'. The article advances negotiated order theory by providing an in-depth examination of the ways in which medical-administrative boundary-making and boundary-blurring constitute distinct modes of safety in high-volume routines. It also provides the basis for further research and safety improvement to maximise team-level understandings of the pivotal role of medical-administrative negotiations in achieving safety and mitigating risk.

Exploring the clinically orientated roles of the general practice receptionist: a systematic review protocol.

BACKGROUND: The receptionist is the focal point of the practice, undertaking an array of clinically orientated roles such as triaging patients for GP consultations or managing repeat prescribing. However, the full nature and extent of the receptionist's clinical activities is unknown as are the implications for patients. The aim of the proposed review is to explore the nature of the receptionist's clinical roles, their extent and their implications for patients. In doing so, we will highlight any gaps in the evidence base which future research may explore. METHODS: The databases Medline/PubMed, Ovid, Cinahl, ASSIA, Cochrane, EMBASE and Science Direct will be searched for relevant literature. We will look at both qualitative and quantitative research on GP receptionists, based within primary care to explore their roles within the primary care team, the clinically relevant roles they undertake, the extent of these roles and any implications these roles might have. No limits are placed on the date or place of publication; however, only research published in English will be included. Screening, quality assessments and data extraction will be carried out by two reviewers, who are not blinded to study characteristics. Analysis follows a four-stage method, established by Whittemore and Knafl (2005). DISCUSSION: The review will explore existing research covering the clinically orientated roles of the GP receptionist. The findings of the review will be important for healthcare professionals and academics working within primary healthcare. It will highlight and for the first time synthesise research relating to the complex and essential work of the GP receptionist. Our findings will inform the direction and focus of further research, as gaps in the knowledge base will be uncovered. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no: CRD42016048957 .

The care work of general practice receptionists.

INTRODUCTION The care work of general practice receptionists has received limited research attention, despite receptionists position at the beginning of patients' journeys in many health care systems. We examine receptionists' perceptions of their work and the opportunities and constraints they experience in caring for patients while providing administrative support to practices. METHODS Data were collected in focus group interviews with 32 receptionists from urban and rural general practices in the Auckland and Northland regions of New Zealand. We employed tools from inductive thematic analysis and Straussian grounded theory in interpreting the data. FINDINGS We found that the way receptionists identified with a caring role strongly challenged the pejorative view of them in public discourse. Receptionists provide care in two key ways: for the practice and for patients. The juggling they do between the demands of the practice and of patients creates considerable work tensions that are often invisible to other staff members. CONCLUSION Receptionists have a critical role as the first step in the patient care pathway, bridging health care system and community. For general practice to be patient-centred and improve accessibility for the most vulnerable, the care work of receptionists must be considered core. KEYWORDS Receptionists; general practice; care; New Zealand.

A qualitative study of the impact of the implementation of advanced access in primary healthcare on the working lives of general practice staff.

BACKGROUND: The North American model of 'advanced access' has been emulated by the National Primary Care Collaborative in the UK as a way of improving patients' access in primary care. The aim of this study was to explore the impact of the implementation of advanced access on the working lives of general practice staff. METHODS: A qualitative study design, using semi-structured interviews, was conducted with 18 general practice staff: 6 GPs, 6 practice managers and 6 receptionists. Two neighbouring boroughs in southeast England were used as the study sites. NUD*IST computer software assisted in data management to identify concepts, categories and themes of the data. A framework approach was used to analyse the data. RESULTS: Whilst practice managers and receptionists saw advanced access as having a positive effect on their working lives, the responses of general practitioners (GPs) were more ambivalent. Receptionists reported improvements in their working lives with a change in their role from gatekeepers for appointments to providing access to appointments, fewer confrontations with patients, and greater job satisfaction. Practice managers perceived reductions in work stress from fewer patient complaints, better use of time, and greater flexibility for contingency planning. GPs recognised benefits in terms of improved consultations, but had concerns about the impact on workload and continuity of care. CONCLUSION: AA has improved working conditions for receptionists, converting their perceived role from gatekeeper to access facilitator, and for practice managers as patients were more satisfied. GP responses were more ambivalent, as they experienced both positive and negative effects.

What do general practice receptionists think and feel about their work?

BACKGROUND: Although there is some published work acknowledging that the general practice receptionist's role is both important and difficult, receptionists' own views have rarely been sought. AIM: To explore general practice receptionists' ideas and feelings about their work. METHOD: A questionnaire was distributed to all 150 receptionists in a representative sample of 26 practices in the area covered by Leeds family health services authority. Semi-structured interviews were conducted with a representative group of 20 receptionists selected from the questionnaire sample. RESULTS: All responders were women, 60% were over 40 years old, and about half had been in the post for more than five years; four-fifths worked part-time. They had chosen the job because it dovetailed with the rest of their lives. Responders derived satisfaction from helping patients, meeting people, having good relationships with colleagues, and doing varied work. Sources of stress included difficult patients, work pressure, problems finding appointments for patients, and feeling caught between doctors' and patients' demands. Responders' experiences and views of training were diverse. Practice managers were important in making them feel consulted and supported. All had a sense of teamwork with colleagues, but many did not perceive the whole practice as a team. Many felt doctors failed to appreciate the pressure and complexity of their work. CONCLUSIONS: Receptionists' work is complex, demanding and intense, involving a high level of commitment to patients, colleagues, and the practice. Recommendations include improved appointment systems, a positive role for practice managers in relation to reception staff, and individual planning of receptionists' training. Effective teamwork among receptionists should be recognized and developed. General practitioners (GPs) are recommended to develop a greater understanding of receptionists' work.

Changes in receptionists' attitudes towards involvement in a general practice-based trial of screening and brief alcohol intervention.

BACKGROUND: Primary health care receptionists are increasingly expected to be involved in research. However, little is known about receptionists' attitudes to research or health programmes. AIM: To examine changes in receptionists' attitudes, with different levels of training and support, towards involvement in a general practice-based trial of screening and brief alcohol intervention. METHOD: Subjects were 84 receptionists, one per practice, who assisted in the implementation of a screening and brief alcohol intervention programme. Receptionists were randomly assigned to one of three conditions: control (no training or support), training alone, and training plus ongoing telephone support. Baseline and follow-up questionnaires were used to assess changes in receptionists' attitudes. RESULTS: Of 40 items that measured receptionists' attitudes to involvement in the programme, 70% had deteriorated after three months, 20% significantly so. There was no effect of training and support condition. Receptionists' and GPs' attitudes to research and health programmes conflicted. CONCLUSION: Receptionists developed more negative views about involvement in research and health programmes over the three-month study period, regardless of level of training and support.

Managing patient demand: a qualitative study of appointment making in general practice.

BACKGROUND: Managing patients' requests for appointments is an important general practice activity. No previous research has systematically observed how patients and receptionists negotiate appointments. AIM: To observe appointment making and investigate patients' and professionals' experiences of appointment negotiations. DESIGN OF STUDY: A qualitative study using participant observation. SETTING: Three general practices on Tyneside; a single-handed practice, a practice comprising three doctors, and a seven-doctor practice. METHOD: Participant observation sessions, consisting of 35 activity recordings and 34 periods of observation and 38 patient and 15 professional interviews, were set up. Seven groups of patients were selected for interview. These included patients attending an 'open access' surgery, patients who complained about making an appointment, and patients who complimented the receptionists. RESULTS: Appointment making is a complex social process. Outcomes are dependent on the process of negotiation and factors, such as patients' expectations and appointment availability. Receptionists felt that patients in employment, patients allocated to the practice by the Health Authority, and patients who did not comply with practice appointment rules were most demanding. Appointment requests are legitimised by receptionists enforcing practice rules and requesting clinical information. Patients volunteer information to provide evidence that their complaint is appropriate and employ strategies, such as persistence, assertiveness, and threats, to try and persuade receptionists to grant appointments. CONCLUSION: Appointment making is a complex social process where outcomes are negotiated. Receptionists have an important role in managing patient demand. Practices should be explicit about how appointments are allocated, including publishing practice criteria.

How do general practices manage requests from patients for 'same-day' appointments? A questionnaire survey.

Same-day appointment requests are common and can be problematic for general practices that run appointment systems. In a questionnaire survey sent to 90 general practices in one health authority area (response rate 88%), a variety of management systems existed for dealing with same-day appointment requests. Managing the requests was found to be a significant cause of stress for many general practitioners. Registrars, locums, and practice nurses play only a small part in meeting patient demands and few practices operate telephone triage to help manage these requests.

Trainee interns in general practices.

AIM: To determine the impact of trainee interns (sixth year medical students) on general practices involved in medical student teaching. METHOD: Postal questionnaires were sent to general practitioners, nurses and receptionists in each of 30 general practices throughout New Zealand. Questionnaires were also sent to patients in practices where a trainee intern was present during the study period. RESULTS: Nearly all of the general practitioners, receptionists and nurses found advantages in having trainee interns. Advantages included enjoyment of teaching and personal satisfaction from student involvement in the practice. Two thirds felt that the advantages would increase if the attachment duration was extended. General practitioners reported an increased level of stress and decrease in productivity, with greater hours at work per week. Remuneration was considered inadequate by a third of the general practitioners. Patients found trainee intern involvement advantageous, with improvement in quality of both care and communication. Disadvantages included longer waiting time and longer appointment time. Younger patients were more likely to find disadvantages than older patients. CONCLUSION: Trainee interns in general practices can have a beneficial impact on the quality of primary care. There are disadvantages for health care professionals and patients, and appropriate compensation (in money or time) is important for community undergraduate medical education to continue to be acceptable.

The unspoken work of general practitioner receptionists: a re-examination of emotion management in primary care.

Dealing with illness, recovery and death require health care workers to manage not only their own emotions, but also the emotions of those around them. While there is evidence to suggest that core occupations such as nursing are well versed in the nature of and need for such work, little is known about the requirements for emotion management on the part of front-line administrative staff. In response, findings from a three-year ethnographic study of UK general practice, suggest that as a first-point-of-contact in the English health care system GP receptionists are called upon to perform complex forms of emotion management pursuant to facilitating efficacious care. Two new emotion management techniques are identified: (1) emotional neutrality, and (2) emotion switching, indicating a need to extend emotion management research beyond core health occupations, while at the same time reconsidering the variety and complexity of the techniques used by ancillary workers.

Working the waiting room: managing fear, hope, and rage at the clinic gate.

In this article, we outline the contrasting perspectives of patients and receptionists and the different ways they experience waiting rooms in three U.S. medical clinics. We are doing this to show that a consideration of waiting rooms and the receptionists who work there is an important step in understanding the patient care-seeking experience. We describe the kinds of conflicts that emerge around patient waiting and the emotional labor that receptionists perform to reduce these conflicts by managing patient feelings. By doing this we expand the frame of the clinic visit to include the emotionally important space of the waiting room and revisit the concept of "emotional labor" as a way to understand non-medical care giving in clinic settings and the cultivation of emotions in others. In doing so we show the important role that clinic receptionists may play in shaping how and when patients receive health care.

Receptionists' experiences of occupational violence in general practice: a qualitative study.

BACKGROUND: The significance of occupational violence in general practice is well established, but research has focused almost exclusively on the experiences of GPs. Only limited research has examined the role of general practice receptionists despite their acknowledged vulnerability to violent patient behaviour. No qualitative research has explored this problem. AIM: To explore the experiences of general practice receptionists regarding occupational violence and the effects of violence on their psychological and emotional wellbeing and on their work satisfaction and performance. DESIGN OF STUDY: Qualitative study. SETTING: Constituent practices of an Australian network of research general practices. Practices were located in a range of socioeconomic settings. METHOD: Semi-structured interviews were conducted with practice receptionists. The interviews were audiotaped, transcribed, and subjected to thematic analysis employing a process of constant comparison in which data collection and analysis were cumulative and concurrent. Qualitative written responses from a cross-sectional questionnaire-based study performed concurrently with the qualitative study were similarly analysed. RESULTS: Nineteen interviews were conducted and 12 written responses were received. Violence was found to be a common, sometimes pervasive, experience of many receptionists. Verbal abuse, both 'across the counter' and telephone abuse, was the most prominent form of violence, although other violence, including assault and threats with guns, was reported. Experiences of violence could have marked emotional and psychological effects and could adversely affect job satisfaction, performance, and commitment. CONCLUSION: It is apparent that occupational violence is a whole-of-practice problem and strategies for GP and staff safety will need to take a whole-of-practice approach.

Users' attitudes to an electronic medical record system and its correlates: a multivariate analysis.

Implementation of an electronic medical record (EMR) system increases efficiency of health services, quality of care and patient satisfaction. Successful implementation depends on many factors, one of which is how users respond to the new system. We studied medical receptionists' appraisal of the newly implemented EMR system in primary healthcare centres in Kuwait. Four hundred receptionists were selected randomly from different healthcare centres and asked to complete a user interaction satisfaction questionnaire relating to their experience of the new system. The response rate was 80.5%. A large majority of the respondents considered the system to be flexible (83%), easy (89%), and satisfying (81%). However, more than one third of the respondents (36%) found the system inadequate. Bivariate and multivariate analyses found age, typing ability, ease of data entry and computer error as significant correlates with overall user response. These findings relating to users' reactions to various aspects of the EMR should assist policymakers to recognise the causes of dissatisfaction with the EMR among medical receptionists at health centre clinics that may adversely affect its successful implementation and regular use, as well as the quality of care provided by the clinics. In addition, the findings provide information to assist the development of guidelines for future implementation of the EMR system at the secondary healthcare level.

Receptionists' perceptions of violence in general practice.

BACKGROUND: Violence and threatening behaviour towards health care employees is a recognized hazard. There is a lack of research into the perceptions of general practice (GP) receptionists about this important workplace hazard. AIM: To determine the factors that influence reception staff perceptions regarding the risk of future violent and threatening incidents at work. METHODS: A cross-sectional survey using a self-administered postal questionnaire was carried out among reception staff working in 49 GPs in two UK National Health Service Primary Care Trusts. RESULTS: Forty-nine (72%) practices agreed to participate. Two hundred and seven (68%) reception staff participated. Receptionists who reported having been threatened or attacked in the past 12 months were more likely to be worried about being threatened [odds ratio (OR) 4.9; 95% confidence interval (CI) 2.0-11.8] or attacked (OR 4.6; 95% CI 1.8-11.2) in the future. Receptionists with higher neuroticism scores were more worried about the future possibility of violence. Staff who felt safe and supported at work (P = 0.003) and staff who had lower background sources of stress at work (P < 0.001) were less likely to feel they would be threatened or attacked at work. Staff who had received training about violent and abusive incidents felt safer at work (OR = 1.27; 95% CI 1.04-1.55). CONCLUSION: Previous episodes of threats or attacks at work make receptionists more worried about future episodes. Factors which reduce reception staff anxieties about violence and threat at work are working in a supportive environment where work stressors are controlled and receiving training on how to deal with violent, threatening and difficult behaviour.

Modifying the behaviour of doctors and their receptionists in recurrent stressful situations.

Doctors and receptionists in a group practice completed a questionnaire about the image of the practice and reactions to recurrent stressful situations. The results were shared among the participants in a way that preserved anonymity. A year later a further questionnaire was completed which showed that respondents perceived that beneficial changes had taken place. The changes were seen as being mainly due to an increase in mutual understanding between the doctors and their receptionists.

Receptionists, appointment systems and continuity of care.

The influence of receptionists on continuity of care in four group practices was examined. Twenty two receptionists were observed making 543 appointments and afterwards were interviewed about their personal priority for continuity of care. One of the practices ran a personal list system. It was found that the personal list practice attracted more requests for a specific doctor and time which were then more difficult to satisfy. Most receptionists thought it was important that patients should see the same doctor but their influence seemed to be small compared with that of the doctor as expressed in practice policies. Marked variation in demand for individual doctors was seen in two of the practices without a personal list system.