How should doctors manage workplace interruptions? A qualitative study in UK hospital outpatient departments
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Background
Interruptions are common in hospital outpatient departments (OPDs) and are linked to error. Many are clinically necessary, so the aim is to regulate them. Most interventions target the individual clinician. Little is known about how doctors manage interruptions in practice or what makes their strategies work.
Methods
Qualitative study using focus groups and interviews with 42 doctors working in UK National Health Service OPDs (19 sessions, September to November 2025). Participants were purposively sampled by clinical experience and self-reported patient complexity. Data were analysed using Framework Analysis, informed by Cognitive Load Theory and Social Identity Theory.
Results
We developed four themes. (1) Pre-emptive protection of attention . Doctors withdrew, signalled unavailability and set thresholds for interrupting. These depended on colleagues learning and sharing the norm, which staff rotation eroded. (2) Sharing the burden through team coordination . Designated roles and time-limited rotas moved interruptions to colleagues with capacity set aside for them and made interrupting legitimate. (3) Real-time cognitive repair . Doctors asked interrupters to wait while they secured the task, and rebuilt the consultation on return, sometimes with the patient’s help. Asking a colleague to wait depended on seniority or team membership; some trainees described difficulty doing this with senior colleagues. (4) Organisational recognition as the precondition for sustainable regulation . Where supervision was built into job plans, the interruptions it generated were expected and doctors held capacity in reserve for them. Advice, vetting and telephone queries were rarely counted as work.
Conclusions
Each strategy served a cognitive purpose, and social and organisational conditions decided whether it was perceived to work. Interventions could make norms shared and roles explicit, count interruption work in job plans and keep routes open for junior staff to raise concerns. Evaluations should ask who is able to use them.
WHAT IS ALREADY KNOWN ON THIS TOPIC
Interruptions are common in clinical work and can disrupt task completion, while most interventions focus on individual clinicians and have shown mixed effects.
WHAT THIS STUDY ADDS
Doctors described strategies to protect attention, redistribute interruptions and repair disrupted tasks, but their use depended on shared norms, legitimate roles, social standing and organisational capacity. Some trainees described difficulty asking senior colleagues to wait, although trainee representation in this sample was limited.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
Departments could agree urgency thresholds alongside clear routes for non-urgent requests, use time-limited roles for queries and recognise advice and supervision in workload planning. Evaluations should assess who can use these arrangements and whether staff can still escalate concerns.
