Organisational, hygiene- and team-related changes in German general practices during and after the COVID-19 pandemic: a participatory cross-sectional survey among medical assistants (WiSBAH study)

BACKGROUND: Even before the COVID-19 pandemic, the daily work of medical staff in general practices was characterised by high stress levels; during the pandemic there was a further increase in workload. In response, many practices implemented organisational and hygiene-related measures primarily to maintain patient care and infection control, which also affected working conditions, particularly for medical assistants (MAs). This study aimed to investigate the MAs’ perspective on changes in practice organisation, hygiene, and team interaction that facilitated their work during the COVID-19 pandemic. METHODS: This study was conducted as a cross-sectional study among MAs within the North-Rhine Westphalia General Practitioner Research Network (NRW-GPRN). The questionnaire was developed participatorily in eight focus groups with 50 MAs and refined through cognitive pretesting. Data were collected anonymously via LimeSurvey between August and December 2023. Descriptive analyses were performed in SPSS. RESULTS: A total of 355 questionnaires were completed by MAs. Almost all (n = 343, 96.6%) reported that the GP practice they worked in had introduced telephone consultations at the start of the pandemic; about one third reported implementation of video consultations (n = 109). Both measures largely facilitated the work of MAs. A change in internal work processes during the pandemic was reported by 41.1% (n = 146) of employees due to changed responsibilities and by 28.5% (n = 101) in connection with changed working hours, and changes were partly perceived as a reduction in workload. Additionally, 38.6% reported improved team communication, which further contributed to a reduction in workload. Furthermore, most MAs (60.6%) considered stress reduction measures useful during periods of high workload and named a variety of measures that could help cope with stressful work phases. At the same time, nearly two thirds (63.1%) felt burdened by the increased risk of infection even after the pandemic. Consistent with this, 74.5% (n = 264) reported continuing to wear masks when dealing with acutely infected patients. CONCLUSIONS: This study highlights how organisational adjustments, role clarity and team communication were perceived by MAs during and after the COVID-19 pandemic. While the survey does not allow causal inference or assessment of psychological constructs, the findings provide practical insights for improving workload management and supporting MAs in general practice.