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.

The Impatient Patient and the Unreceptive Receptionist: Darnley v Croydon Health Services NHS Trust [2018] UKSC 50.

In Darnley v Croydon Health Services NHS Trust [2018] UKSC 50, the Supreme Court held that a hospital receptionist's misleading statement about A&E waiting times constituted a breach of duty and that the claimant's decision, based on this misinformation, to leave the hospital did not break the chain of causation when he was left paralysed as a result of a head injury. In this commentary, I argue that while the Supreme Court's treatment of duty of care and breach is, for the most part, a model of doctrinal clarity, its treatment of the causation issue is problematic as it elides the test of whether there has been a break in the chain of causation with that for remoteness. I then comment on the Supreme Court's construction of the patient in medical negligence cases.

Protocol for using mixed methods and process improvement methodologies to explore primary care receptionist work.

INTRODUCTION: The need to cope with an increasingly ageing and multimorbid population has seen a shift towards preventive health and effective management of chronic disease. This places general practice at the forefront of health service provision with an increased demand that impacts on all members of the practice team. As these pressures grow, systems become more complex and tasks delegated across a broader range of staff groups. These include receptionists who play an essential role in the successful functioning of the surgery and are a major influence on patient satisfaction. However, they do so without formal recognition of the clinical implications of their work or with any requirements for training and qualifications. METHODS AND ANALYSIS: Our work consists of three phases. The first will survey receptionists using the validated Work Design Questionnaire to help us understand more precisely the parameters of their role; the second involves the use of iterative focus groups to help define the systems and processes within which they work. The third and final phase will produce recommendations to increase the efficiency and safety of the key practice processes involving receptionists and identify the areas and where receptionists require targeted support. In doing so, we aim to increase job satisfaction of receptionists, improve practice efficiency and produce better outcomes for patients. ETHICS AND DISSEMINATION: Our work will be disseminated using conferences, workshops, trade journals, electronic media and through a series of publications in the peer reviewed literature. At the very least, our work will serve to prompt discussion on the clinical role of receptionists and assess the advantages of using value streams in conjunction with related tools for process improvement.

Slaying the dragon myth: an ethnographic study of receptionists in UK general practice.

BACKGROUND: General practice receptionists fulfil an essential role in UK primary care, shaping patient access to health professionals. They are often portrayed as powerful 'gatekeepers'. Existing literature and management initiatives advocate more training to improve their performance and, consequently, the patient experience. AIM: To explore the complexity of the role of general practice receptionists by considering the wider practice context in which they work. DESIGN AND SETTING: Ethnographic observation in seven urban general practices in the north-west of England. METHOD: Seven researchers conducted 200 hours of ethnographic observation, predominantly in the reception areas of each practice. Forty-five receptionists were involved in the study and were asked about their work as they carried out their activities. Observational notes were taken. Analysis involved ascribing codes to incidents considered relevant to the role and organising these into related clusters. RESULTS: Receptionists were faced with the difficult task of prioritising patients, despite having little time, information, and training. They felt responsible for protecting those patients who were most vulnerable, however this was sometimes made difficult by protocols set by the GPs and by patients trying to 'play' the system. CONCLUSION: Framing the receptionist-patient encounter as one between the 'powerful' and the 'vulnerable' gets in the way of fully understanding the complex tasks receptionists perform and the contradictions that are inherent in their role. Calls for more training, without reflective attention to practice dynamics, risk failing to address systemic problems, portraying them instead as individual failings.

Receptionists in intake in community health.

Receptionists are employed as administrative assistants, but in Community Health Centres, especially rural ones, they are the first step in service delivery, the intake system. This has implications for the people seeking services and for receptionists. This paper looks at receptionist data from an intake study alongside relevant literature and makes findings relating to the occupational health and safety (OH&S) of receptionists and for intake systems.

Primary care office responses to a stroke scenario.

PURPOSE: One previous study found that healthlines affiliated with academic neurology programs recommended non-emergent treatment for a hypothetical stroke scenario almost one quarter of the time, which could contribute to patients presenting too late for time dependent stroke therapies. We assessed the treatment advice given in a hypothetical stroke scenario by primary care physician offices across the United States. METHODS: We obtained a national listing of United States primary care physician offices from Yellowpages.com, and selected a systematic random sample of numbers to call. The respondent answering the phone was presented with a standardized, scripted stroke patient scenario, and asked to choose one of four responses that could be provided (wait for symptom resolution, attempt to schedule an office appointment later in the day, schedule an office visit within two days, call 911 for ambulance transport to a hospital). RESULTS: Forty-two respondents completed the survey (average age = 43 years; 88% female), with 29% (95% CI 17%-44%) recommending scheduling an appointment later in the day if symptoms do not resolve. The remaining respondents recommended calling 911. When presented with a heart attack scenario, 100% of respondents recommended calling 911. CONCLUSIONS: Almost one third of the primary care physician offices recommended scheduling an appointment later in the day for a hypothetical stroke case, despite always giving the correct answer of call 911 for a classic heart attack scenario. These results suggest that stroke education with specific emphasis on the need to call 911 may be needed for primary care physician office receptionists.

[Coworkers in focus. An analysis of video recordings from receptions in general practice--a method of self evaluation of the coworker and for future development of cooperative forms in general practice]. / Medarbeideren i fokus. Analyse av videoopptak fra legekontorets resepsjon--en metode til selvevaluering av medarbeideren og til videreutvikling av samarbeidsformer i en legepraksis.

The article describes a simple method for self-assessment and group-assessment of video recordings from the reception area in a general practice. In a group setting, the method was found to increase the receptionists' confidence in their own professional skills and revealed the need to pay more attention to communication between patients and receptionists. The layout of the reception area was rearranged and changes in the daily routines in the practice were suggested.