We used Hackman and Oldham’s theory of work design (28) to help us understand how the characteristics of a receptionist’s roles can resonate psychologically in terms of the meaningfulness of their role, the level of responsibility assumed, and the outcomes of their work. These criteria are fundamental to intrinsic motivation their emotional connection to the results of their actions and the overall success of their contribution
We found that receptionists reported a high level of autonomy and variety in the work they do though were relatively uncertain as to the impact and success of their individual contribution perhaps linked to the lack of regular feedback from their colleagues. They were required to process a high level of information and employ a wide variety of skills but . the ergonomic and physical impact of their work was low. Below we describe these findings in more detail within each of the four domains of the WDQ; Task characteristics, Knowledge characteristics, Social Characteristics, and Work Context.
Strengths and limitations
Seventy participants completed the WDQ, in the 12 months the study was open; falling short of the expected sample size. As there is no centralised list of practice receptionists in England either at CCG or national level multiple means of recruitment and dissemination were undertaken with limited success and it may be appropriate to class GP receptionists as a potentially hard to reach group (34). The smaller sample size presents limitations for the validity and generalisability of the findings. However, while the sample size is limited, the characteristics of the receptionist reflect those identified in previous research i.e. they are most likely to be female, white and middle aged (10, 35, 36). In addition the participants were drawn from geographically diverse locations across England and a range of practice sizes (37). As such, it is representative of a range of GP practices and primary care environments across England and the WDQ has provided the first quantitative insight into the design parameters of the role of receptionists. It has highlighted key aspects of their work and provided evidence of areas where additional support may prove beneficial particularly in addressing the high cognitive load inherent in their work.
Comparison with existing literature
Increasingly, modern surgeries are multi-disciplinary teams consisting of clinical and non-clinical staff each undertaking a range of inter-related tasks to successfully deliver care (38-41). As such the work the receptionist undertakes is varied (9-11, 42-45) and straddles both clinical and non-clinical responsibilities (9-11, 14, 16-19, 43, 46-51). In doing so the receptionist juggles multiple sources of information from patients, colleagues, and external agencies, often with competing demands on attention. For example, they can be required to check patients into the practice while simultaneously taking phone calls (17, 52). Such variety in tasks can be rewarding (26, 27) but may also lead to an overtaxed and underperforming workforce (26, 27).
In other work environments such as aviation, issues of competing demands and multitasking have been tackled by introducing concepts such as the ‘sterile cockpit’ which prohibits extraneous activities such as non-essential communication or reading non-essential materials during the critical phases of the flight (53). Cognitive processing is undertaken serially and so multi-tasking is effectively “task-switching” between multiple tasks effectively sharing attention sequentially (54). This process slows down work and errors are more likely directly after the ‘switch’ has occurred (54, 55). Of course not all interruptions are negative and it must be acknowledged that where they provide the information needed for task completion (59) they are beneficial (60). Similarly where tasks are routine, distractions can speed information processing without concomitant negative effects on accuracy (59, 61).
The implications of excessive cognitive load are especially important in healthcare where demand is high, information often incomplete and time constrained (56-58). Distractions, interruptions, and external extraneous stimuli disrupt attention and can lead to error (56, 57). For reception work, separating tasks may reduce the likelihood of error in complex tasks, for example separating greeting patients and answering the telephone into discrete roles may help to reduce error by minimising the interruptions encountered when undertaking these roles simultaneously. Similarly, complex work with potentially serious implications for patient safety such as repeat prescribing would benefit from being undertaken as a separate activity to reduce the cognitive load of multitasking (54, 55, 62).
The receptionist undertakes a number of roles that at times require specialised knowledge including triage (15, 20, 21), and repeat prescribing (21, 22). However, no formal qualifications are required (10, 15) and much of the training that exists is provided in-house from existing reception staff (36, 42, 63, 64) and viewed by many receptionists as inadequate (10, 42, 63, 64). Barriers to improving this training including time constraints, and a lack of funding and relevant courses (65). Recently this training shortfall has been acknowledged and in 2017 Health Education England, established a £45 million fund to support training in two discrete roles, managing medical correspondence and active care navigation (66) though its effect on quality, safety and staff satisfaction is as yet unknown.
Social support in the workplace including constructive feedback from colleagues helps underpin well-being (67, 68) and psychological and behavioural functioning (69) in a range of jobs and environments, including policing (70) hospitality (71) and healthcare (69, 72). Our sample described the level of feedback only as ‘moderate’ yet receptionists have previously described its importance to their well-being and job satisfaction (10, 42). Though systematic mechanisms for providing feedback to receptionist staff exist, such as annual performance reviews and appraisals, (73) the time constrained and high pressured atmosphere of modern general practice precludes other avenues for providing the type of informal social support that can improve well-being (74). The social connection with colleagues also helps engender in reception staff a grasp of the outcomes of the work they complete; understanding the implications of their actions can help increase motivation, enable mistakes to observed constructively and in the case of receptionists contribute to a framework for monitoring and improving performance (28).
Work environment directly affects an employee’s ability to perform their role (25-29). Receptionists are some of the most visible members of the practice team (16), their front of house position can bring them into contact with difficult or aggressive patients (75) or otherwise leave them feeling dissociated from the rest of the primary care team (42, 43). Although their location in the practice is unlikely to change, some of the negative effects might be mitigated by the opportunity for receptionists to share their experiences with supervisors and colleagues (76, 77).
The receptionist regularly uses information technology (IT) to manage patient data and service delivery. These clinical software systems are used to manage patient records, prescribing, test results and appointment bookings as well as facilitating communication from GPs to receptionists (78). Despite their pivotal role a a recent survey found that 12% of receptionists received no training in their use despite evidence of errors linked to their misuse (15, 21). A sociotechnical perspective is one theory that has previously been adopted to improve the fit between individual and IT system and can be used to ensure the design of healthcare IT is better informed by the context of the individual and their work environment (79).