I recently ran a training session for a group of receptionists about how important their contribution to patient safety is relation to repeat prescribing.
I referred to a piece of research in the BMJ last autumn about receptionist input to quality and safety in repeat prescribing.
The receptionists were delighted. Several planned to get a copy of the article to use as a basis for discussion in the practice.
Why? Because the importance of their contribution had been recognised in print and - even better - in a medical journal.
Further research in March 2013 BJGP ‘Slaying the dragon myth: an ethnographic study of receptionists in UK general practice’ did the same.
Both articles recognise that receptionists have a complex, demanding job and, importantly, that they take responsibility for patient welfare.
They are medical receptionists in preference to having a job in a local shop, which may well pay about the same. So what can GPs and practice managers do to capitalise on this resource?
Your reception team will mainly come from the same community as your patients. If they didn’t actually grow up with some of your patients, they will have other connections and will know patients by sight and often by their voice.
They may speak the same languages and use local accents and idioms.
The receptionists are an excellent resource when you are undertaking any kind of planning as they really know how well your systems work (or not) and how they impact on patients. Get them involved as much as you can and see the difference this makes.
Receptionists are usually working under time pressure, and perhaps some of the systems the practice uses are adding needlessly to this?
For example find out:
- If elements of your systems or office layout cause them additional pressure.
- How much time they spend chasing up information which should already have been captured.
- The amount of time wasted trying to ‘catch’ the GPs for the bestowal of, for example, a signature?
Tools such as the Productive General Practice system can help practices analyse what is happening across the whole organisation as well as at the front desk.
Systems can be reviewed with team involvement and streamlined. This will result in less wasted time, less stress and (a useful by-product) more value for money.
Receptionists' low status
The myth of dragon receptionists is that they are jealously guarding appointments and only giving them out under duress. This can make them seem powerful.
In reality, receptionists have no positional power in the organisation, little knowledge power (as they are not medically trained) and only perceived resource-based power.
The resources - appointments - they have to give are controlled by the GPs and the receptionists have to work with what they are given.
Additionally, receptionists commonly feel uncomfortable about asking patients about the reason they want an appointment or being forced to make clinical decisions about urgency.
Minimise patient risk
Practices working closely with their receptionists when designing appointment systems and call-handling algorithms, often find ways of managing access which do not repeatedly place receptionists in a difficult position.These often minimise patient risk.
Patient behaviour can also be managed to help their interactions with reception. Use resources such as your website, newsletters and handouts to inform patients about how to make best use of, for instance, the appointment system, repeat prescription service and how to contact the doctor.
Different GPs, different systems
I meet a lot of receptionists who tell me the GPs at their practice all like things done in different ways.
Receptionists are put in the position of handling potentially high-risk pieces of information in individualised, varied ways and often have to make judgements.
The research shows that, despite this, their priority is patient safety and that they are generally good at picking up inconsistencies such as medication under- or over-use or missed messages. But this leaves a lot to luck.
CQC registration in England has helped many practices re-focus on high risk systems, and quality awards such as the RCGP’s Quality Practice Award help practices do the same.
Consistent protocols that are regularly reviewed (and to which everyone then adheres) help eliminate the pressure to make judgements.
Protocols to review
As a minimum the following protocols are particularly worth reviewing regularly:
- When to interrupt the doctor or nurse
- Handling urgent and non-urgent messages
- Dealing with emergencies – what is an emergency, how to recognise it, what action to take)
- Making urgent and routine appointments – how to use the appointment system and how to signpost patients to the right contact for their needs
- Results handling – confidentiality, what to say to patients, how they can speak to the doctor
- Repeat prescriptions – requests for prescriptions, collecting prescriptions
- Confidentiality and the Data Protection Act
|How not to do it|
Here is an example of you can demoralise receptionists.
Your receptionist has just spent a good few minutes at the front desk explaining to an insistent patient that she is not able to deviate from the practice’s access protocol.
She tells the patient that, no, they will not be able to 'have a quick word' with you, their preferred GP, just now without an appointment.
The patient has started to behave unpleasantly. You come past the desk, hear what is going on, and see the patient immediately. Problem solved, from your point of view.
You don’t bother raising the awkward issue of how the patient was treating the receptionist. The receptionist inwardly sighs and looks at job opportunities online when she gets home.
The value to the whole practice of handling situations like this differently should not be underestimated.
The value of training
Receptionists are not all saints. I am often asked by practices to deliver ‘customer care’ training for the whole team. My first question is always: ‘Is there a particular individual at whom this is aimed?’
Use appraisal and one-to-one catch-ups to identify issues with skills and attitudes. Give effective feedback and consider what kind of training, if any, would be appropriate, and have in place good performance management procedures.
However, do make sure that you are not blaming an individual for the position in which they have been put.
- Fiona Dalziel is a practice management consultant. www.dlpracticemanagement.co.uk