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 work, the level of responsibility assumed and the outcomes of their work. These criteria are fundamental to intrinsic motivation, and how successful their work has been, enabling them to learn from mistakes and connect emotionally to the result of their actions.
Our participants reported a high level of autonomy and variety in the work they do though were relatively uncertain as to the success of their individual contribution. They were required to process a high level of information and employ a wide variety of skills yet did not regularly receive feedback from their colleagues. 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
The survey was conducted amongst a number of GP practices and primary care environments across England (34) and the WDQ provided the first quantitative insight into the parameters of the role of receptionists, highlighting key aspects of their work and suggesting areas where additional support may prove beneficial. However we do not claim our results are generalizable, as though the demographic characteristics of receptionists in our group reflect those of previous studies; (10, 35, 36), our sample size is smaller than preferred and so our findings do not necessarily reflect those of every receptionist and general practice. Unfortunately the recruitment of a broader sample of receptionists was hindered by the lack of a centralised list of reception staff in England, which is perhaps a contributory factor as to why they remain a seemingly hard to reach research population (37).
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 booking patients into the practice while simultaneously taking phone calls (17, 52). High variety can be rewarding (26, 27) but can also lead to an overtaxed and underperforming workforce (26, 27).
In other environments such as aviation, issues of competing demands and multitasking have been tackled by introducing the idea of a ‘sterile cockpit’ which prohibits extraneous activities such as non-essential communication and 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 and so attention is shared sequentially (54). This process slows down work and errors are more likely directly after the ‘switch’ has occurred (54, 55).
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). Conversely, interruptions can be beneficial, offering information sharing needed for task completion (59), an alternate perspective, increasing positive affect (60) and when tasks are routine, distractions can speed information processing without concomitant negative effects on accuracy (59, 61). 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 from triage (15, 20, 21), to 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 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 is as yet unknown.
Social support in the workplace 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 as ‘moderate’ yet receptionists have previously described how important it is to their well-being and job satisfaction (10, 42). Though systematic mechanisms for providing feedback to receptionists 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 social support that might improve well-being (74). This social connection also helps engender in reception staff a grasp of the outcomes of the work they complete. In other environments understanding the implications of their actions can help staff increase motivation and enable mistakes to be observed constructively (28) and could also be used to provide a framework for receptionists to monitor and improve performance.
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 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 (65) 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 informed by the context of the individual and their work environment (79).