Table 2

Mitigation and management strategies for patient aggression towards general practice receptionists

  • 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

  • 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

  • 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

  • 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

  • Strategies established as effective are in bold.