Job Redesign – UWHC Receptionist

By: Kel Chakphet, Rachel Hinkes, Kurosh Ruch-Kamgar, and

Mike Wisnefsky

Industrial and Systems Engineering

University of Wisconsin – Madison

Submitted for ISyE 653, Professor Carayon

December 16, 2009

Table of Contents

Executive Summary ………………………………………………………………………3

Methodology ……………………………………………………………………………...4

Job Evaluation …………………………………………………………………………….6

Redesign Constraints ……………………………………………………………………10

Job Redesign …………………………………………………………………………….11

Conclusion ………………………………………………………………………………17

References ………………………………………………………………………………... i

Appendix A

References from Update II ………………………………………………………. ii

Appendix B

Presentation Outline ……………………………………………………………. iii

Observation: Northeast Clinic Example ………………………………………... vi

Appendix C

Pluses and Minuses: Referencing Job Analysis ……………………………….. ..ix

Appendix D

Gantt Chart ………………………………………………………………………..x

Appendix E

Chart Evaluating Job Redesign Effects on Specific Job Minuses ……………….xi

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Executive Summary

In this project, our team worked with different UW Health Clinics in Wisconsin to

improve psychosocial aspect of the receptionist position. Our project goal was to provide

an in depth analysis and evaluation on work system elements (task, individual,

organization, environment, and technology) of receptionists at UW health clinics with the

intent to propose a redesign solution that aims to eliminate/reduce obstacles,

inefficiencies, and common stressors. Our team in coordination with receptionists and

clinic managers was able to obtain useful feedback, concerns, suggestions, and other

qualitative data. After data collection was completed, each element of the work system

was analyzed based on the psychosocial aspects within them, as supported by the Job

Enrichment Theory, the Theory of Stress, the Balance Theory, and the Scientific Model.

Interaction with others (doctors, nurses, technicians), job variability, good relationships

within the receptionist office, and easy use of technology were classified as positive

factors in a receptionists work system. On the other hand, disparity in training methods,

temperature comfort levels, noise disruptions, and patient privacy issues were classified

as negative elements in the system. Obstacles were taken into consideration when making

our job redesign suggestions. For all redesign suggestions we maintained or improved the

utility levels of all positive facilitators already existing within the job position.

We recommend hiring an external consulting group to develop a standard operating

procedure for each task and a training procedure to be followed by all receptionists. We

expect to see a reduction in role ambiguity, stress, and inefficient work methodology as a

result of our job redesign suggestions.

Noise and temperature discomfort has lesser flexibility on the redesign; however, we

were able to reach a redesign conclusion. For temperature control, we proposed

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distributing a survey to determine the “preferred” temperature for receptionists. We also

proposed receptionists be able to voice their concerns about temperature control to

management, in an effort to eliminate “learned helplessness within the job.” For noise

control, relocating printers and faxes and using sound barriers would immensely reduce

the noise traffic in receptionist work areas.

Performing all of these redesign suggestions will improve the receptionist job position

throughout the UW Clinic system.  As receptionist’s jobs improve, they will be able to

work better, and patients will receive a better experience when interacting with them.

These improvements to the receptionist position will make UWHC a healthier and more

productive place to give and receive healthcare.

Methodology

Since our Job Analysis of the receptionist position, we have continued observations and

analyses. Observations have been done specifically at the Verona, Northeast, and Wingra

locations. These have contributed to our final report through ‘filling-out’ our sense of the

essence of UWHC work-systems; and through conversations with supervisors,

receptionists, and observations of staff, we have gained the perspective out of which we

have been able to put forward our final recommendations.

Our timeline was updated from the previously offered Gantt chart (Appendix D).

Specifically, our refined method was to use our analyses, progress report, and revised job

analysis to compile pluses and minuses and develop meaningful redesign solutions. New

observation data, such as information found in Appendix B, also contributed to the

selection of pluses and minuses to be focused on, as well as providing further evidence

for the development of our redesign ideas.

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The roles over this stage of the project process changed slightly to a structure of division

of responsibilities, rather than a structure based on roles. Rachel, however, was

instrumental in organization and structuring the completion and subsequent compilation

of the separate parts of the project. Special tasks included developing a presentation,

which comprised of putting together an outline, and designing and writing the slides. The

latter was primarily done as a team, while Rachel drew up this outline and started each

piece of the project for us. Further, in writing the report, Kurosh focused on topical

choices and citations; Michael and Kel focused on data linkages.

Observations were conducted using the now-familiar work-system model of tools, tasks,

organization, individual and environment. While at the several clinics, data was also

collected by simply recording information that could potentially be viewed as important

later. Our group has found that data synthesis tools frequently arise out of the direction of

the data itself. For example, in previous reports we had gathered data into charts, as

required by the objectives of developing a survey of the receptionist position. In kind,

our redesign has required focus on themes, which have emerged from the data in the form

of pluses and minuses; those pluses and minuses that have accumulated the most

integrated data and attention, after analysis, thought, discussion and re-observation, have

here made up the bulk of our redesign solutions. Specifically, the tools we have used, as

data collection requirements have matured, were outlines and observation ‘write-

ups’(Appendix B). The writing and execution of our outlines both answered and asked

questions of what we needed to further know. Our presentation, for example, served as a

seminal meeting and initial forming of ‘blocks,’ out of which ideas, found herein, were

sculpted. And so the process of putting together a job redesign involved a continual

refinement of outlines, supported by other peripheral datum. Conveniently, these outlines

have been very useful as coordination tools. They, and the writing and editing of this

very paper, represent a nexus of work and body of evolving production. We, are pleased,

thus, to present the final and formal verison of our job evaluation and redesign of the

receptionist position.

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Job Evaluation

We used results from our job analysis to conduct a job evaluation. The job analysis

consisted of questionnaires, phone interviews, personal interviews, and on-site

observations. A table of the questionnaire results has been created and can be found in

our report on job analysis (Table 1, at the bottom of page 8). The interviews and

observations served the purpose of following up on ‘leads’ and information received

through the questionnaires as well as the purpose of gathering data and developing

understanding of clinic operations.

The results from our job evaluation are summarized in Table 1. The italicized bullet

points are areas that affect the psychosocial aspects of a receptionist’s job and are the

areas we will be focusing on throughout the rest of this report. A table in Appendix C

has been modified with page numbers that will direct you to the areas in Report 1 from

which the pluses and minuses were created.

Table 1. Plus/Minus Evaluation

Pluses Minuses

o Interaction between doctors, x-ray techs, and medical records

o Job rotation to medical records

o Variety of tasks

o Adequate storage space

o Good Relationship among colleagues

o Computers are easy to use

o Enjoy providing service

o Non-consistent practices

o Disparity in training method length

o Lack of communication

o Temperature and air quality issues

o Low patient privacy

o Noise disruptions

o Lack of writing space

o Dealing with rude customers

o Physical pain from holding phone

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We will first discuss why the interactions receptionists have with doctors, x-ray techs,

and medical record staff (p. 10 – Report 1) is a psychosocial plus of the job. Using

Herzberg’s theory of job enrichment it is evident that interactions aid in psychosocial and

professional growth by creating a sense of achievement, responsibility, advancement, and

opportunity (Appendix A – Update II, paragraph 2). A receptionist can feel a sense of

achievement and responsibility when she completes tasks that aid in the work of other

University of Wisconsin Health Clinic staff. These tasks can include scheduling

appointments for appropriate times, correcting claims, registering patients, and taking

important messages for either nurses or providers. Advancement and opportunity for

receptionists are created through the same interactions by allowing receptionists to build

their skill base, which creates the potential for receptionists to advance to other positions

within the clinic.

Receptionists have also reported that they are motivated to provide the best service

possible to patients (also referred to in Appendix A - Update II, paragraph 2). According

to Herzberg’s theory of job enrichment (Carayon, Job Characteristics Approaches

Lecture), they have grown with the job, while providing service and receiving direct

feedback in the form of acknowledgement and kind words throughout their career.

Overall, receptionists have become experts in patient handling, both on the phone and in

person. This sense of expertise allows them to interact with patients in an experienced

and comfortable manner.

Following the same theory the ability for direct communication with authority is also a

benefit to the psychosocial area of the job. Receptionists are able to communicate with

doctors and administration, which allows them to learn how to fulfill their tasks in a way

that best benefits the clinic. This essentially allows for the receptionists to continue

learning throughout their career. They learn how certain doctors prefer messages to be

written or how management would like reports to be filled so that they are easier to read;

in the words of one receptionist from the Wausau clinic, “we are always learning

something new every day!”

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The method of the Balance Theory indicates interactions, within the receptionist position

that are found to be a benefit with regard to social contact and support, may be

categorized as a plus or positive (Smith and Carayon, 2001). By opening communication

and allowing interactions throughout the clinic, receptionists have a wide base of support

systems to reach out to with problems, concerns, or questions. Another facilitator we

found from our analysis is positive relationships between co-workers (p. 26 – Report 1).

Good relationships are the base of a healthy work place, and this quality certainly helps

“balance” the mental load keeping receptionists form being over-stressed.

The next aspect we will discuss is why a variety in tasks (p. 16 – Report 1) presents a

plus in the psychosocial area of a receptionist’s job. Again referring back to Herzberg’s

theory of job enrichment, task variety creates opportunity for new learning and control

over personal and office resources. Because receptionist jobs are mainly focused on

assisting walk-in patients and phone call patients, the time they will be busy actively

serving them will vary significantly (Job Analysis, Tasks – line 6-8). Since the time

serving the patients varies it is necessary to have other tasks for receptionists to perform

during the downtime (p. 10 – Report 1). These tasks can vary from brochure folding to

taking online courses. The variety of tasks and the introduction of new tasks on a regular

basis create a constant opportunity for new learning and for new skills to be developed.

The control over resources, previously mentioned, mainly refers to the receptionist’s

ability to order supplies as needed and to allocate her time and personal resources as she

sees fit. The variety in a receptionist position allows this decision-making aspect; this

creates a sense of responsibility and control, which, according to the Karasek model of

job strain, aids in physical and psychosocial growth and helps to reduce stress (Carayon,

Job Stress and Well Being Lecture).

Interactions with others and a variety in tasks have proven to be positive psychosocial

areas of a receptionist’s job. We will now discuss three of the psychosocial minuses that

we found throughout the job evaluation. The minuses we will discuss include disparity in

training methodology, temperature and air quality issues, and noise disruptions.

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Disparity in training is an important minus because it equates to a lack of standards (p. 2

– Report 1). The scientific method discussed in class suggests that scientific methods or

standard operating procedures are more beneficial to job design than rule of thumb

methods. Management currently has little insight regarding methods of operation because

no standards exist against which to measure performance. The lack of standards also

makes it hard to compile information and documents created by different receptionists

throughout the UW clinics. Role ambiguity also results from an absence of standards;

because there are no standard operating procedures, a receptionist may not know exactly

what he is responsible for within his job.

The next two issues will be discussed together. Temperature and air quality and noise

disruptions (p. 19-20 – Report 1) abet psychosocial stress by creating psychological

‘loads.’ The Balance Theory and the Theories of Stress by Hans Selye both suggest that

people develop physiological reactions to environmental demand (Carayon, Job Stress

and Well-Being Lecture). This is a negative impact arising from the current job design of

receptionists. If a receptionist comes to work dreading the cold environment she will be

in all day, she may already have psychologically impacted her ability to perform in an

open and inviting manner because she will be disquieted by the omnipresence of the

temperature stressor. To add to this, cold temperatures have been shown to reduce both

finger dexterity and psychomotor function (Karsh, Physical Workload Heat and Cold

Stress); and given that a receptionist’s job involves primarily her vigilance and

attentiveness (Job Analysis, Individual Characteristics – paragraph 2) and manual

dexterity – for the purpose of using her computer and phone and for the purpose of

handling files - the presence of cold may both interfere with the performance of her job

tasks and also lead to feelings of incompetence and helplessness over the long-term.

Similarly, if noise is a constant irritant and problem, it can produce negative

psychological responses that cause the receptionists to be frustrated and stressed; this

again hinders their ability to perform as they should. Possible impacts of this could

include an inability to focus on tasks or an inability to address patients in an easy manner,

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so to at least not increase the patients’ potential discomfort (as a result of vulnerability)

throughout their experience at the clinic.

These last points segue into our final issue with the receptionist position at the UW

Health Clinics. Receptionists have very repetitive and high-volume tasks to complete

throughout the day, including handling incoming phone calls and serving arriving

patients (p. 16 – Report 1). In line with the concept of burnout, jobs with a high degree

of contact with people in need may result in feelings of emotional exhaustion and even

callousness or cynicism (Karsh, Lecture 10 – Job Stress). These are clearly not healthy

for anyone, let alone people working in as critical a healthcare role as the receptionist

position; and yet we have seen evidence from responses on our questionnaires indicating

a degree of emotional stress (p.16 - Report 1). As stated in our Job Analysis in line 4 of

the first paragraph under the section Individual, “Upon analyzing our questionnaire data,

we realized that meeting with unhappy/angry patients is one of the issues receptionists

like least about their job. Even when call volume gets overwhelming, the receptionists

have to stay calm and collected in order to do their job effectively.” Even if the signs of

stress may not qualify clearly as symptoms of burnout, we assess that this stress

represents an important issue of concern (Maslach, Schaufeli, Leiter, Job Burnout, 2001).

Redesign Constraints

Before we discuss our redesign suggestions, we would like to state a few constraints in

which we need to design upon. Knowing our constraints, we can guarantee the direction

we choose for the redesign, as well as reduce possible conflict within the team. First of

all, we are aware that controlling noise level of patients or co-workers is not practical. In

fact, it could even create more stress in the work place and reduce customer satisfaction

(p. 19 – Report 1). Although excessive noise is one of the main minuses found in our

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analysis, it would be in the best interest of the clinics if to avoid human noise level

control.

Affected by the downturn of the economy, our project provider suggested we should not

propose hiring more employees or upgrading their positions because UWHC is currently

under tight budget constraints. Along with budget constraints, we must also take clinic

size into consideration. We are redesigning a single job for eight different clinics that

each have different resources, technologies, and job settings. Smaller clinics and larger

clinics have different capacities and requirements as well that we need to consider in

order to create appropriate redesign suggestions that will provide practical solutions for

all clinics.

Physical obstacles such as neck strain and suboptimal ergonomic equipment, which can

lead to various pains and strains, will not be included in our redesign. We believe it is fair

to include these obstacles in our report, especially cumulative neck pain due to poor

headset quality because it is one of the major complaints, however due to our limited

knowledge in physical object redesign, we will not provide recommendations for such

areas.

Job Redesign

Once the job evaluation was completed and we had narrowed our focus down to the

pluses and minuses discussed above our team came up with a list of problems that lead to

the minuses and solutions for them. Table 2 outlines the problems along with our

suggested solutions.

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Table 2. Problems and Solutions for Job Redesign

Problems Solutions

Non-Standard Training Procedure Standardize Training Procedureo Consulting Groupo Create SOP’so Find and Solve Work-Arounds

Temperature and Noise Control Moderate Temperatureo Survey to Determine Desired

Temperature

Reduce Noiseo Move Machines to Different Areaso Put Up Sound Barriers

From Table 2 we see that the main problems affecting the psychosocial aspects of a

receptionist’s job are non-standard training procedures and temperature control and noise.

We used the scientific model, Herzberg’s job enrichment, balance theory, and Hans

Selye’s theories of stress to define the problems and then to help us design solutions that

would solve the problems.

To standardize training procedures we suggest hiring a consulting group to come in and

monitor procedures throughout all clinics. After they have collected the appropriate data

we would like them to create standard operating procedures based on the data they

collected. We would also expect the consulting group to find and solve work-arounds by

creating standard operating procedures that adjust for the reasons people currently use

work-arounds.

We came to these conclusions by referencing the scientific model. The suggested solution

will decrease role ambiguity by creating a standard to be followed. Receptionists will

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know what specifically they are accountable for and many uncertainties will be removed.

The solution will also streamline processes and essentially create a system that will

produce consistent outputs. This will all around reduce the stress levels of receptionists.

We also referenced Herzberg’s job enrichment theory when designing our solution. We

specifically referenced the area of new learning. By creating standard operating

procedures we will need to ask all receptionists that are not currently following the new

standard procedures to learn them and begin using them. New learning will decrease

some of the repetitive duties done in a receptionist’s job, which can lead to new

motivation and an increased interest in work. In addition to these temporary benefits, we

propose that the new standards will create an environment that encourages and creates

dialogue over ‘best practices,’ thereby unifying and creating a sense of identity within the

receptionist position itself.

To implement these new standards, we propose the use of a big bang along with phased

implementation (Eason, 924-926). We suggest consulting groups come in immediately to

observe and create SOP’s. Once the SOP’s have been created they should be

implemented immediately, in a big bang concept, for all new employees being trained.

For employees that have been working as a receptionist for some time and have

developed their own methods we would like to see the new SOP’s implemented through a

phased implementation. Management should set schedules and start dates for all new

SOP’s. The receptionists should then be required to learn the new material and begin

following the new procedures by the determined dates. Implementation of standard

operating procedures could begin with file-keeping (simple), and move to more involved

procedures such as handling patient phone calls.

.

This solution may be fairly costly, however we believe solving this problem would be

extremely beneficial to the psychosocial aspects of a receptionist’s job. We propose the

use of a consulting group because they would be completely unbiased to the procedures

they are seeing. If people within the company were chosen to standardize procedures they

might create biases towards the ways they have learned to do the very procedures subject

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to standardization. This can lead to frustration within clinics if receptionists feel they are

not being represented fairly and can also lead to suboptimal solutions if a bias determines

the solution.

The next problem we suggest to solve is that of temperature control and noise. We

propose surveys be given to all receptionists within each clinic and determine what the

desired temperature is at each clinic based on the results. We also suggest that

management or the receptionists themselves can move according to their comfort

preferences with respect to the varying temperatures within their operating area. What we

mean by this is that, given differences in work-climate preferences, receptionist’s that

prefer the temperature to be cooler should move closer to the air conditioning vents and

receptionist’s that prefer to be warmer should be placed away from the vents.

To solve the noise problem we propose moving machines such as printers and fax

machines away from the immediate area that the receptionists sit in. The machines should

be placed in a convenient location that is easily accessible to the receptionists, but far

enough away that the noise from the machines will not carry into their workspaces. If

there is not a physical room or place that these machines can be moved to we suggest

they place barriers around the machines. Cubicle like walls can be placed around the

machines in a way that the machines are still easily accessible, but the majority of the

noise from them will be blocked out by the walls.

To define these two solutions we referenced the balance theory and Hans Selye’s theories

of stress. We believe that our solutions will reduce physical and psychological stress

loads due to environmental irritations and distractions. This will in turn lead to a more

balanced work system. We also believe that by allowing the receptionists to be active in

the solution to temperature control and noise levels they will not feel a sense of ‘learned

helplessness’ that we believe is present now. The receptionists will be able to act in

response to the irritations and distractions surrounding their workplace, which will limit

the irritation that would otherwise continue to develop out of a feeling of not being in

control.

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To implement the suggested solutions for temperature control and noise we would like to

see the use of big bang concepts as well as trials and dissemination (Eason, 927). Loud

machines should be moved immediately if possible. If not possible, sound barriers should

be put in place as soon as possible. As far as temperature control, we suggest surveys be

done immediately and workstations be changed according to temperature preference with

respect to the physical layout of the workspace. After the surveys have been collected we

would like to see the temperature adjusted as desired by the receptionist staff. Once the

temperature has been changed for a period of time a new survey should be sent out to

determine if the overall satisfaction of receptionist’s with respect to temperature control

has increased. If satisfaction has not increased a new trial should be done.

With the temperature control solution we are aware that some suggestions might not be

possible, because the clinics need to keep the rooms comfortable for their patients first.

There may be set guidelines that need to be followed in this regard as well. We still

suggest the aforementioned solution; however it can be limited to within reasonable

means of the clinics.

Over the longer term, we recommend a program of participatory involvement in

decisions regarding the office environment in which the receptionists work. To continue

with both Karasek’s theory concerning job control and Herzberg’s theory concerning job

enrichment, a program whereby receptionists were afforded the opportunity to provide

input and, to an extent, ‘control’ the status of their environs, would significantly improve

the receptionist position at UWHC. The program would involve a formal query of

receptionist perception whenever changes regarding their environment or tool use were

considered. This query would follow attendance at related meetings, by one lead

receptionist who could debrief others, or by receptionist interest on an individual basis.

Finally, a brief meeting to gather feedback and reflect on changes made would allow the

process a degree of completeness and reflection.

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As a final solution to present, we would like to draw upon an opportunity to accentuate

the aforementioned pluses of task variety and socialization, while further mitigating the

minuses of high-volume repetition and associated symptoms of burnout. We have seen

that the provider scheduling responsibilities are segregated from the receptionist job

duties. At the Wingra clinic, for example, provider scheduling is its own job. We

propose that this function be combined with the receptionist function so that receptionists

may ‘break’ from the high-volume and expectable unpredictability of demands placed

upon them by the responsibilities of the clinic phone (Appendix B, Observation of

Northeast Clinic – Individual). This would have several benefits, the first of them being

that a window-receptionist would now be free to respond to visiting patients at all times –

the phone would no longer present a source of stress for the patient, and therefore the

receptionist, on whom the onus of looking after the patients falls. Secondly, this move

would allow a greater availability of receptionists concerning incoming phone calls,

which would serve to reduce the overall load of incoming phone calls on the

receptionists, by distributing demands over a wider pool of resources. Finally, greater

socialization in the form of more intimate, less stressed interactions with patients,

undisturbed by the constant threat of interruption by incoming phone calls, would

enhance the existing essential characteristics of receptionist social interactions.

Moreover, integration of the receptionist position with providers and other related

organizations would also enhance and augment the core characteristic of receptionists as

the ‘hub’ of clinic operations. Gains in role identity could be reasonably anticipated.

Adjusting the window receptionist responsibilities would require a big-bang

implementation approach, and we recommend this be done immediately, so that standard

operating procedures could be written with the new division of labor to account. We do

not anticipate great difficulty with this change, and benefits ought to accrue immediately.

In complement with existing job rotations, a receptionist would gain exposure to a major

aspect of clinic operations - that of interfacing with providers who are frequently

involved in other related hospitals and organizations, such as medical schools.

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The job analysis and job evaluation our group performed support the given job redesign

suggestions we have created. Throughout the job analysis we were able to find areas that

created pluses and minuses that were pointed out in our job evaluation. From the job

evaluation we were able to narrow our focus down to appropriate psychosocial job

redesign possibilities that were discussed in detail in this section. The job redesign

concepts were then qualified using models and theories we learned in ISyE 653.

Conclusion

Our data has shown that UWHC receptionists suffer from both lack of standardized

training, which produces a lack of standardized output and role ambiguity, and a stressful

workplace due to temperature and noise.  We addressed the first issue by proposing a

neutral third party to create standard operating procedures for the receptionists and to

adjust the system so that non-standard procedures were less likely to be performed.  We

feel this will produce more standardized, efficient results, as well as insure that every

receptionist knows exactly how to do everything, reducing role ambiguity.  The second

major issue, environmental stressors such as sound and temperature created “loads” that

need to be balanced.  We achieved this in three steps:  moving the printers and faxes,

placing sound barriers by them, and taking a survey on ideal temperature.  This will

reduce the noise and stress caused by being too warm or too cold, reducing the load it

produces.  Performing both of these plans will improve the receptionist job position

throughout the UW Clinic system.  As the receptionist job improves, they will be able to

work better, and patients will receive a better experience when dealing with them. With

these improvements in the receptionist position, the UWHC will be a healthier and more

productive place to give and receive healthcare.

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References

Carayon, Pascale. Job Characteristics Approaches Lecture. IE653. Oct 26, 2009.

Carayon, Pascale. Job Stress and Well-Being Lecture. IE653. Nov 4, 2009.

Eason K. D. (2005). Ergonomic interventions in the implementation of new

technical systems. In Wilson J.R. and Corlett E.N. (eds). Evaluation of

Human Work. Taylor and Francis, London, 3rd Edition 919-932.

Karsh, Ben-Tzion. Lecture 10 – Job Stress. IE349. Nov 5, 2009.

Karsh, Ben-Tzion. Physical Workload Heat and Cold Stress. IE349. Nov 5, 2009.

Maslach, C., Schaufeli, W.B. & Leiter, M.P. (2001). Job burnout. Annual Review

of Psychology, 52, 397-422.

Smith, M.J. and Carayon, P. “Balance Theory of job design” In The International

Encyclopedia of Ergonomics and Human Factors, edited by W.

Karwowski, London: Taylor & Francis, 2001, pp.1181-1184.

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Appendix A

From Update II - Individual

Problems with the individual are not evident or likely to present great difficulty to

the position of the receptionist/MPA.  At all the clinics visited, training is usually

conducted 'on the job,' by peers, and covers simple responsibilities.  While these

may be complex in contingencies and logistics, as administrative processes can

be, it is our sentiment that learning which occurs in a hands-on, piecemeal way

provides the most manageable and customizable training regimen. 

The individuals who have been interviewed have appeared to be reliable,

supportive, and social people who enjoy a routine and stable work-environment,

and enjoy helping others.  Nevertheless, it is clear from our questionnaires and

interview data that even such people of immense capacity to serve, have their

limits.

ii

Appendix B

Presentation Outline

Job Analysis

Questionnaire

Designed from Carayon Job Interview

Information gives us a general overview of the 5 elements of the

work system model.

Tasks

Individual

Environment

Organization

Tools/Technology

Phone Interview

(List of Clinics Contacted)

Acquired a brief overview of job tasks and ideas for improvement

Observations and Personal Interviews

Locations: Belleville, Verona, Northeast, and Wingra

Allowed us to see the physical environments

Personal Interviews – Confirmed interview results, ask follow up

questions

SHOW RESULTS ACCORDING TO WORK SYSTEM MODEL … TABLE?

Make Connections as directed to in Report 1

Job Evaluation

Slide – Table of results from questionnaires

List of Pluses and Minuses

iii

Justify why the pluses and minuses are pluses and minuses with

respect to job design theories

Pluses: Computers are easy to use; Interaction with Doctors, X-

ray techs, and medical records; job rotation to medical records;

adequate storage space.

Minuses: disparity in training method and length; tasks are not

performed exactly as they have been taught; temperature and

air quality affect comfort levels; noise disruptions; low patient

privacy; non-consistent practices, lack of communication, lack

of writing space.

Balance Theory: working conditions produce physical and psychological ‘loads’.

‘Loads’ may lead to adverse health effects. Balance of positive and negative attributes –

aim to achieve a ‘balanced’ work system.

Scientific Method: Substitute scientific methods for rule of thumb methods. Duties of

management – develop method, train, teach, and develop workers.

Job Enrichment – Herzberg: Motivators are the factors that meet man’s need for

psychological growth, especially achievement, responsibility, advancement, and

opportunity.

Direct feedback – Client Relationship – New Learning – Scheduling – Unique

Expertise – Control Over Resources – Personal Accountability – Direct

Communications Authority

Theories of Stress: Hans Selye – body’s physiological reactions are activated by any

environmental demand (Temp and Noise). Current Stress Theories – interaction between

the work environment and the individual (Writing Space and Key Board).

Other: Social contact and social support. Role ambiguity / Role conflict. Feedback.

iv

Job Redesign

Table of Problems and their Solutions. (only the ones we are working on)

1 [No standard training procedure, work-arounds, inconsistent

practices]

2 [Temperature is too cold/humidity, Noise from machines]

3 [Lack of privacy / confidentiality]

4 [Need for further education]

(This may be too many problems to focus on – I’m not sure)

Solutions:

1 [Consulting group comes in to monitor and standardize training

procedures throughout all UW clinics. Observe work-arounds and

determine why they are taking place in order to implement a

solution, standardize all training and practices through careful

observation and analysis]

2 [Temp – do an anonymous poll of staff workers and ask them if

they are comfortable at work. Adjust temperature accordingly. If

there are inconsistency in results move people that like to be cooler

near AC vents etc. Noise – remove fax machines, printers, etc.

from immediate work area of receptionists]

3 [Noise reduction should aid in this area. Print address cards

before patient visit to verify address visually instead of verbally]

4 [Management needs to monitor technology and practice

advancements – hold training sessions or allow for outside classes

to be taken to allow for knowledge of the new things to be gained]

(Obviously need a lot more detail for the report on how each problem will be solved.)

Link all problems and solutions to the job design theories listed previously.

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(We might want to break the presentation up into one problem and solution at a time

instead of presenting one piece of each as we go.)

Discuss how we will implement the solutions to each of the problems.

Greenfield site, Big bang, Parallel Running, Phased

Implementation, Trials and Dissemination, Incremental Evolution

Remember we can use a combination of these to implement

a single solution.

List of Sources

Observation from Northeast Clinic Sample of data collected at each location.

Time: 9:30 am – 10:30 am on Monday

Work System Elements:

Individual:

Most of the receptionists look rather stress working in their workstations. Though,

for the receptionists at the front desk, they manage to smile and greet customer with very

positive attitude. During observation, call volume was fairly overwhelming for them, but

the receptionists were very calm and collective in doing their job professionally without

showing any rush or nerve.

Tasks:

Receptionist responsibility can be categorized by the location of her workstation.

Receptionists at the front/welcome desk are mainly responsible for communicating with

walk-in patients, and the other receptionists locating in the same area are responsible for

picking-up calls. Nonetheless, front desk occasionally answer calls as well. Receptionists

at northeast clinic are not responsible for billing and medical record update, as the task is

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assign to another position in the clinic. Call duration ranges from under a minute to ten

minutes, and there are several actions receptionist can perform: redirecting calls, transfer

calls, take messages, and give information, for instant. Patients are served on a first come

first serve basis; therefore, efficiency of each respond is very crucial. Supervision office

locates right next to the reception area, and she helps with call handling when all the

receptionists are busy.

Tools and technology:

Multi-line phone, printer, and computer there is no technology burden. On the

physical side, holding a phone between head and shoulder create neck muscle fatigue

over time, and the problem can only accumulate unless we can bring a new technology to

aid this aspect of their work. Additionally, one of the receptionist said that they would not

use headphone either because it makes them uncomfortable moving around.

Currently, northeast clinic is going through revamping their computer operator to

make it more efficient at directing calls. This is a good step to reduce the unnecessary

work for the receptionists. When it is done correctly there would be less call drop as well,

a win-win situation for the customers, the hospitals, and most notably, the receptionists.

Physical Environments:

Illumination, ventilation, temperature, and humidity are all okay.

Noise is a concern. People in the waiting area (approximately 10 meters away

from the reception area) can easily hear every word receptionists speak on the phone. I

am not sure how they manage to get all the information on the phone when there are at

least six of them speaking at the same time, in the close proximity. Nonetheless, noise

does not seem to bother them at all.

Organizational conditions

Most of the front desks have assigned workstations, but they do move when they

are assigned to cover another area. Co-worker seems to be fairly nice and friendly toward

each other. By nature of a first come first serve services, receptionists get really good at

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spreading responsibility. Once a call comes in, idle receptionist almost automatically pick

up the phone showing decent degree of teamwork.

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Appendix C

Pluses Minuses

o Interaction between doctors, x-ray techs, and medical records (10)

o Job rotation to medical records(9-10)

o Variety of tasks(16)

o Adequate storage space (11)

o Good Relationship among colleagues(26)

o Computers are easy to use(9)

o Enjoy providing service(26)

o Non-consistent practices(2 + all of Report 1)

o Disparity in training method length(8)

o Lack of communication(10)

o Temperature and air quality issues(19-20)

o Low patient privacy(19)

o Noise disruptions(15,19)

o Lack of writing space(20)

o Dealing with rude customers(14)

o Physical pain from holding phone(15)

The numbers in parenthesis represent the page number each item was derived from in Report 1.

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Appendix D

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Appendix E

This is a chart of how each redesign solution aims at fixing the minuses of the receptionist job at UWHC. Please note that we specifically aimed to eliminate the psychosocial aspects we learned about in this class.

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