Why is abusive behaviour in health care considered ‘a normal workplace hazard’?

Research from the University of Queensland (UQ) has found that physical and verbal abuse of medical receptionists by patients is not only rife but causes lasting effects on staff too.

Receptionists are frequently subjected to verbal abuse from patients such as shouting, swearing, accusatory language and racist and sexist insults, according to Dr Fiona Willer, Senior Research Fellow at UQ's Centre for Community Health and Wellbeing.

“They also face armed and unarmed physical violence.”

These behaviours can have a major impact on receptionists’ wellbeing, as they report workplace stress, burnout and lasting physical trauma.

“Only a small proportion received professional counselling, and unfortunately coordinated support for reception staff was generally lacking,” Willer said.

Abusive behaviour considered ‘normal workplace hazard’

The abusive behaviour medical receptionists face has been accepted as a “normal workplace hazard”, according to Willer.

“For anyone working in HR, this is a storm coming because it's workplace conditions they have to experience day on day out [that] shouldn't be considered acceptable in this day and age,” she told HRD Australia. “Virtually any other professional role would say this is absolutely unacceptable.”

The research involved a review of 20 studies across five countries – Australia, the UK, the United States, Spain and Ireland – and analysed the aggression faced by receptionists in medical clinics and doctors’ surgeries. The researchers focused on family GPs rather than urgent care environments that were attached to hospitals.

Because of the way primary care is organised, particularly in Australia, it can be difficult for receptionists to speak up, Willer said.

“It's mostly a small business enterprise, sometimes it's a multi-business enterprise,” she said. “But for the most part, the primary care practices are just nestled in the community with owners that also work in them. And so they don't really have a voice and unionise, there's very little way that they can speak collectively to their experience.”

Various issues cause patient frustrations

The researchers looked at studies done between the 1970s and 2022 and found similar issues among patients despite the adoption of digital technology.

“It was interesting that patient frustration seemed to be similar in that if they couldn't see the doctor, in what they felt was a time that was within their expectations, that's obviously a point of frustration,” Willer said.  

“Also [it’s about] things that are perennial issues like billing and getting test results, access to prescriptions. But the biggest one is really around scheduling. And we found consistently that it was coming up in literature that this is what patients were frustrated about. And this overflowed into hostility and aggression towards the receptionist.”

Despite the impact on receptionists, Willer said “we didn't see a whole heap of urgency to transform that element in primary care.”

“The receptionist still bore the brunt of those frustrations and kind of acted… as human shields for bad systems selected by primary care,” she said.

How HR can address workplace abuse

The research highlighted effective and ineffective methods to protect medical receptionists. Strategies that were more likely to reduce patient aggression were the early availability of appointments, streamlined scheduling systems, and consistent patient management practices. What was found to be ineffective included “zero tolerance” campaigns, clear acrylic barriers and lockable doors.

“It looks to me like when you start to say things like ‘Be nice to receptions, don't be hostile, don't be aggressive’, put up these Perspex barriers, make it only key access or code access to reception spaces – although that makes the staff feel safer, it also makes the patients feel less safe and supported in an area where that supportive environment is part of the therapeutic effect of primary care,” Willer said.

So it's a bit of give and take… these are, in my mind, strategies that don't deal with the actual core problem, which is the reasons people are getting frustrated, not the end effects.”

While the researchers looked at data done pre-COVID, the effectiveness of certain strategies mentioned could have changed, she said.

“We can't say for sure that those strategies that were ineffective beforehand will still be ineffective.”

Nonetheless, HR leaders should ensure they listen to their workforce, Willer said.

“My first recommendation would be to engage with this workforce and help them understand that they're part of an actual workforce rather than just being a receptionist at a medical clinic,” she said. “Because they're often quite isolated in terms of professional identity and being able to connect with others in similar roles, but at other organisations.”

Another suggestion is to learn from other service roles.

“We can also draw a lot from the other frontline service roles – hospitality, tourism, food service, retail… where you do have clients and customers being very frustrated,” Willer said. “It's always a difference between customer expectation and capability of delivering on that expectation that gives rise to frustration.”

Ultimately, more research needs to be done to support medical receptionists, she said.

“We need a lot more research, further engagement with primary care [and] receptionists… to see what really does truly help them because that's really what our systematic review found – that they've been ignored for too long.”