It is a management truism that businesses run better when employees are engaged.Businesses with highly engaged employees are more than twice as successful as other companies, a Gallup study of 50,000 businesses and more than 1.5 million employees in 34 countries found.
Specifically, high employee engagement resulted in:
• Lower absenteeism
• Lower staff turnover
• Less shrinkage (by pilfering employees)
• Fewer safety incidents
• Fewer product defects
• Higher customer metrics
• Higher productivity
• Higher profitability
The findings are similar in healthcare organisations, where those with high employee engagement have 41% fewer patient safety incidents.
In general practice, high levels of engagement are particularly important for front-line staff.
The organisational behaviour literature refers to such employees as “boundary spanners” linking the inside of an organisation to the outside world.
These staff members often have conflicting roles, performing both customer-facing and administrative tasks, usually at the same time.
In a GP surgery, the receptionist juggles the front desk, the telephone, doctors’ schedules, patient and Medicare, and medical records. They need to deal with patients who are often stressed or in pain, while at the same time making vital decisions about who gets to see the doctor and when. Some researchers now claim that the dyadic doctor-patient relationship in primary care has been superseded by the triumvirate of doctor-receptionist-patient.
While doctors have been quick to seize the benefits of this shift, research suggests that patients have been somewhat slower, with empirical and anecdotal evidence indicating receptionists are frequently viewed by patients as a barrier rather than a facilitator in their quest for effective healthcare.
What is commonly overlooked by patients, and sometimes doctors, is the important role receptionists play in emotional management. The concept of emotional labour – managing your feelings and expressions to fulfill the emotional requirements of a job – has emerged as an important area of research, charting the progress of the global economy as Western nations move from manufacturing-based to service-based economies.
As well as juggling patients, constantly ringing phones, record-keeping and medical staff, receptionists work in the knowledge that relations with patients (and staff) are ongoing: when dealing with people in front of them, they need to take into account past encounters as well as how today’s encounter may affect future relations.
In addition to empathising with patients, another emotional behaviour that has been observed in medical receptionists is emotional neutrality – suppressing emotions while displaying unemotional behaviour.
A landmark study of UK medical receptionists (Ward and McMurray 2011) found that emotional neutrality “mask(s) the complexity of caring for those who can be reluctant to accept it. Therefore, performances of emotional neutrality may embody both extremes, often being instrumental in their delivery but caring in approach”.
Such apparently dispassionate behaviour may help evoke a sense of calm or acceptance in others, but may also be key to avoiding emotional burnout on the part of the receptionist.
He or she has to keep control of their own feelings and remain neutral in the face of extreme emotions, the authors wrote.
“As we carried out our research, it soon became clear that this apparent lack of feeling acts as a shield against emotional exhaustion,” they said.
Effective medical receptionists are able to switch rapidly between being caring and being business-like, tailoring their approach to the needs of individual clients.
Ward and McMurray say that the process of switching “serves to ensure patients are treated with compassion and care specific to their individual circumstances, which, while being unique to the patient, are experienced by receptionists as a complex flow of emotional changes”.
The authors argue that this emotional roller coaster – “called on to deal with death, joy, anger, aggression, sadness and disillusionment, potentially in the space of an hour” – makes the job of a medical receptionist a surprisingly complex service role which requires “the commitment of individual receptionists to deliver care that is usually associated with higher status healthcare occupations”.
Emotional neutrality can be a double-edged sword, as some patients are put off by emotional-distancing techniques – they want a bit more positive emotion from the receptionist. These patients also resent the barriers being placed between them and their doctor.
Similarly, while in some cases practising emotional neutrality may protect against burnout, in others it may increase the stress on receptionists as they hold their true feelings in check.
This constant “fake friendliness” may even be a factor in depression, some researchers believe.
Getting the right fit
The importance of a waiting-room environment that puts patients in the right frame of mind before their consult has been widely acknowledged, if not always practised.
However, the most patient-friendly waiting room in the world won’t do the job if the person behind the reception desk is uncaring, brusque or inefficient. Employing a medical receptionist is arguably the most important hiring decision you will make – just as important as recruiting the right doctors.
So how do you make sure you’ve got the right team in place at your front desk?
Relevant experience is the most important thing to look for. Have applicants been in a work situation juggling both front-of-house and backroom activities? Have they worked with angry and stressed customers? This doesn’t necessarily have to be in a healthcare setting, though that helps.
Furthermore, when hiring a medical receptionist, it really pays to ask behavioural questions; get candidates to tell you about a tough situation with a customer/patient and how they resolved it.
Have they got the right attitude? This is more of a gut instinct call. They need to be positive but realistic, empathic but also focused on outcomes. They need to be a good listener, reflecting rather than reacting to patients and staff. While some people think a bright, bubbly personality is the main characteristic to look for, you should avoid applicants who are constant chatterers, or those who appear unfailingly happy but can’t handle the inevitable daily crises of a medical practice.
Importantly, do their references check out? They may perform well in an interview, but you need to know how they have handled real-life situations. Contact referees directly and don’t be afraid to ask hard questions.
And once you find a medical receptionist who is a good fit for your practice, make sure you hang on to them. Pay them well, be flexible about holidays and childcare arrangements, and say thank you often.
The benefits to your patients and your practice will be more than worth it.
Dr Ray Welling (not that kind, the other kind) is a writer, publisher and lecturer