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

Hammond, Jonathan; Gravenhorst, Katja; Funnell, Emma; Beatty, Susan; Hibbert, Derek; Lamb, James L.; Burroughs, Heather; Kovandžić, Marija; Gabbay, Mark; Dowrick, Christopher; Gask, Linda; Waheed, Waquas; Chew‐Graham, Carolyn

doi:10.3399/bjgp13x664225

Cited by 49 publications

(72 citation statements)

References 12 publications

(18 reference statements)

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“…We also know that practice staff struggle to identify and action changes based on survey feedback alone [16]. This paper follows a growing body of research that demonstrates how evidence endogenous to interactions provides novel insights into how communication works, which can then inform training and interventions [17,18], which has been reported as near absent for GP receptionists [3]. The paper therefore identifies some key indicators of (in)effective patient care, and provides an evidence base from which to develop interventions that are relatively cheap and do not require large-scale organisational changes.…”

Section: Introductionmentioning

confidence: 95%

“…Some academic research supports this notion by highlighting receptionists' strong intermediary role in their everyday dealing with patients [8,9]. But most studies draw a more nuanced picture, suggesting that particular complexities and constraints in the receptionists' job affect their ability to facilitate patient access [3,6,10]. While such complexities may affect patient outcomes, in this paper we are interested in such factors only in as far as they become relevant for meeting requests.…”

Section: Introductionmentioning

confidence: 97%

“…We focus on the way receptionists meet patients' requests, and how the interaction progresses when something stands in the way of meeting the request. Given the importance of GP receptionists in facilitating patients' access to primary care, there is surprisingly little research on their interactions with patients [3][4][5][6][7]. Studies on patient-receptionist encounters are often reflective of, or responding to, the stereotype of receptionists as 'dragons' or as 'gatekeepers' that is prominent in media discourse.…”

Section: Introductionmentioning

confidence: 99%

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Patient burden during appointment-making telephone calls to GP practices

Sikveland

Stokoe

Symonds

2016

Patient Education and Counseling

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Objective: This study addresses, for the first time, the effectiveness of receptionists handling incoming calls from patients to access General Practice services. Methods: It is a large-scale qualitative study of three services in the UK. Using conversation analysis, we identified the issue of 'patient burden', which we defined based on the trouble patients display pursuing service. We quantified instances of 'patient burden' using a coding scheme. Results: We demonstrate how 'patient burden' unfolds in two phases of the telephone calls: (i) following an initial rejection of a patient's request; and (ii) following a receptionist's initiation of call closing. Our quantitative analysis shows that the three GP services differ in the frequency of 'patient burden' and reveals a correlation between the proportion of 'patient burden' and independent national satisfaction scores for these surgeries. Conclusion: Unlike post-hoc surveys, our analysis of live calls identifies the communicative practices which may constitute patient (dis)satisfaction. Practice Implications: Through establishing what receptionists handle well or less well in encounters with patients, we propose ways of improving such encounters through training or other forms of intervention.

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Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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Patient burden during appointment-making telephone calls to GP practices

Sikveland

Stokoe

Symonds

2016

Patient Education and Counseling

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“…The focus of the observations was on encounters between patients and receptionists at the front desk and encounters between staff within the practices. A more detailed account of this work may be found in the paper by Hammond et al 380 …”

Section: Ethnographic Observationsmentioning

confidence: 98%

Increasing equity of access to high-quality mental health services in primary care: a mixed-methods study

Dowrick

Chew‐Graham

Lovell

et al. 2013

Programme Grants for Applied Research

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BackgroundEvidence-based interventions exist for common mental health problems. However, many people are unable to access effective care because it is not available to them or because interactions with caregivers do not address their needs. Current policy initiatives focus on supply-side factors, with less consideration of demand.Aim and objectivesOur aim was to increase equity of access to high-quality primary mental health care for underserved groups. Our objectives were to clarify the mental health needs of people from underserved groups; identify relevant evidence-based services and barriers to, and facilitators of, access to such services; develop and evaluate interventions that are acceptable to underserved groups; establish effective dissemination strategies; and begin to integrate effective and acceptable interventions into primary care.Methods and resultsExamination of evidence from seven sources brought forward a better understanding of dimensions of access, including how people from underserved groups formulate (mental) health problems and the factors limiting access to existing psychosocial interventions. This informed a multifaceted model with three elements to improve access: community engagement, primary care quality and tailored psychosocial interventions. Using a quasi-experimental design with a no-intervention comparator for each element, we tested the model in four disadvantaged localities, focusing on older people and minority ethnic populations. Community engagement involved information gathering, community champions and focus groups, and a community working group. There was strong engagement with third-sector organisations and variable engagement with health practitioners and commissioners. Outputs included innovative ways to improve health literacy. With regard to primary care, we offered an interactive training package to 8 of 16 practices, including knowledge transfer, systems review and active linking, and seven agreed to participate. Ethnographic observation identified complexity in the role of receptionists in negotiating access. Engagement was facilitated by prior knowledge, the presence of a practice champion and a sense of coproduction of the training. We developed a culturally sensitive well-being intervention with individual, group and signposting elements and tested its feasibility and acceptability for ethnic minority and older people in an exploratory randomised trial. We recruited 57 patients (57% of target) with high levels of unmet need, mainly through general practitioners (GPs). Although recruitment was problematic, qualitative data suggested that patients found the content and delivery of the intervention acceptable. Quantitative analysis suggested that patients in groups receiving the well-being intervention improved compared with the group receiving usual care. The combined effects of the model included enhanced awareness of the psychosocial intervention among community organisations and increased referral by GPs. Primary care practitioners valued community information gathering and access to the Improving Access to Mental Health in Primary Care (AMP) psychosocial intervention. We consequently initiated educational, policy and service developments, including a dedicated website.ConclusionsFurther research is needed to test the generalisability of our model. Mental health expertise exists in communities but needs to be nurtured. Primary care is one point of access to high-quality mental health care. Psychosocial interventions can be adapted to meet the needs of underserved groups. A multilevel intervention to increase access to high-quality mental health care in primary care can be greater than the sum of its parts.Study registrationCurrent Controlled Trials ISRCTN68572159.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…There is evidence that receptionists are torn between their duties towards patients and practices 12,13 and of feeling the need to 'protect' the practice staff and policies. 14 We explore these tensions in the general practice receptionist role in New Zealand. Like Hammond and colleagues, 14 we argue that the work of receptionists cannot be understood in isolation from their work context.…”

Section: Introductionmentioning

confidence: 99%

The care work of general practice receptionists

2016

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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.

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

Cited by 49 publications

References 12 publications

Patient burden during appointment-making telephone calls to GP practices

Patient burden during appointment-making telephone calls to GP practices

Increasing equity of access to high-quality mental health services in primary care: a mixed-methods study

The care work of general practice receptionists

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