When the phone rings - factors influencing its impact on the experience of patients and healthcare workers during primary care consultation: a qualitative study.
BACKGROUND
In the primary health care setting, patients interact directly with their healthcare workers (HCW), which include their primary physicians, nurses and pharmacists. Studies have shown that such interactions, when interrupted by phone calls received by either party, can lead to adverse outcomes and negative experiences. There is insufficient data however on the factors affecting the reaction and responses of both patients and HCWs when phone calls occur amidst their interaction. Understanding these factors will allow for the introduction of targeted measures to mitigate the negative impact of such interruptions and improve patient-HCW relationships. This study therefore aims to understand the impact of unplanned phone calls during primary health care consultations on patient-HCW interactions and the factors affecting the patient and the HCW responses.


METHODS
This study used focus group discussions (FGD) to gather qualitative data from patients and HCWs who had visited or worked in a major public primary healthcare institution in Singapore. The FGDs were audio-recorded, transcribed, audited and analyzed using standard content analysis to identify emergent themes.


RESULTS
15 patients and 16 HCWs participated in 5 FGDs. The key themes that emerged from these FGDs were patients' and HCWs' attitudes toward professionalism and respect, task and thought interruption, call characteristics, the impact on patient safety and stakeholders' experiences. Phone calls during consultations answered by either party often resulted in the answering party feeling apologetic and would usually keep the phone conversations short as a sign of respect to the other party. Both stakeholders valued the consultation time and similarly reported negative experiences if the phone-call interruptions became prolonged. Calls from the desk phone answered by HCWs were perceived by most patients to be relevant to healthcare services, with the assumption that HCWs exercised professionalism and would not attend to personal calls during their clinical duties.HCWs expressed their concerns and distress about potential medical errors due to phone-calls interrupting their clinical tasks and thinking processes. However, they acknowledged that these same phone-calls were important to allow clarifications of instructions and improved the safety of other patients.


CONCLUSIONS
Phone interruptions affected patient and HCW interaction during consultations and factors leading to their adverse reactions need to be recognized and addressed.
SingHealth Polyclinics, 167 Jalan Bukit Merah #15-10, Singapore, 150167, Singapore. Agnes.koong@singhealth.com.sg.|Duke-NUS Graduate Medical School, Singapore, Singapore. Agnes.koong@singhealth.com.sg.
A Y L
AY
Koong
SingHealth Polyclinics, 167 Jalan Bukit Merah #15-10, Singapore, 150167, Singapore. David.koot@singhealth.com.sg.
D
D
Koot
Choa Chu Kang Family clinic, Blk 304, Choa Chu Kang Ave 4 #01-653, Singapore, 680304, Singapore. engsookiang@gmail.com.|Duke-NUS Graduate Medical School, Singapore, Singapore. engsookiang@gmail.com.
S K
SK
Eng
SingHealth Polyclinics, 167 Jalan Bukit Merah #15-10, Singapore, 150167, Singapore. Anna.purani.r.singarasoo@singhealth.com.sg.
A
A
Purani
SingHealth Polyclinics, 167 Jalan Bukit Merah #15-10, Singapore, 150167, Singapore. Azizah.mohd.yusoff@singhealth.com.sg.
A
A
Yusoff
SingHealth Polyclinics, 167 Jalan Bukit Merah #15-10, Singapore, 150167, Singapore. Goh.chin.chin@singhealth.com.sg.
C C
CC
Goh
SingHealth Polyclinics, 167 Jalan Bukit Merah #15-10, Singapore, 150167, Singapore. Stephanie.teo.sh@singhealth.com.sg.
S S H
SS
Teo
SingHealth Polyclinics, 167 Jalan Bukit Merah #15-10, Singapore, 150167, Singapore. Tan.ngiap.chuan@singhealth.com.sg.|Duke-NUS Graduate Medical School, Singapore, Singapore. Tan.ngiap.chuan@singhealth.com.sg.
N C
NC
Tan
D000328:Adult; D001291:Attitude of Health Personnel; D017598:Efficiency, Organizational; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D061214:Patient Safety; D010817:Physician-Patient Relations; D011320:Primary Health Care; D036301:Qualitative Research; D013689:Telephone