| Preventive | Designing clinic layout to protect staff21 Offering a walk-in clinic17 or provision for same day appointments in scheduling system4 30 Regional ‘zero tolerance’ campaign and materials27 (established as ineffective) Engaging patients positively, smiling, making small talk while patients wait for their appointment16 High visibility of clinical staff in reception area17 Reducing frequency of potentially tense points of contact with the receptionists, for example, fewer outbound calls to patients because of better administration systems4 Use of analysis of patient aggression incidents to inform preventive policy29 Strategies to ensure consistent messaging to patients about clinic procedures and expectations from reception and clinical staff23
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| Anticipatory | Development of formal policy/procedure/protocol/action guides relating to management of patient aggression23 24 29 33 Practice meetings/debriefs/regular receptionists supervision group with receptionist safety and management of patient aggression as regular agenda items30 33 Regular staff training for managing patient aggression19 23 24 29 30 Employment of receptionists already experienced in managing patient aggression19 24 Strategies to enhance staff morale, confidence and trust in management29 Recording and tracking of aggressive or perceived to be potentially aggressive patients21 Booking double appointments for patients at higher risk of distress and agitation30 Clinics designed with ‘safe rooms’ and ‘cool down’ spaces24 Provision of locks, alarms, barriers, elevated reception desks, clear acrylic shields between receptionists and patients24 25 32 33
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| Immediate | Receptionists’ own de-escalation techniques developed through experience, for example, apologising,15 16 empathising,15 16 listening15 providing explanations,16 advocating for the patient to the doctor,15 deferring issue to more senior staff24 29 Use of personal alarms24 33 Active listening skills developed during depression signs identification training30 Formal written policy and procedures to refer to, which shift perceived responsibility for issue from the individual receptionist to the practice more generally (de-escalation strategy)17 23 24 Maintain ‘neutral composure’7 and ‘contain the spread’ of agitation within the waiting area15 Calling the police24 33 Offering snacks and water to disgruntled patients15 Encouraging patients to sit in their car or outside if distressed by being in the waiting area, with receptionists calling or texting patient when doctor was ready to see them30
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| Reactive | Removal of patient from practice (ie, they can no longer receive care there)31 33 Systems to document, report and analyse incidents of patient aggression24 29 Change of procedure in response to an incident of patient aggression8 24
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