Who carries the cost of interruptions? A qualitative study of doctors in UK hospital outpatient departments
- 1University College London
Abstract
BackgroundHospital outpatient departments (OPDs) deliver specialist care at scale, under close scrutiny over waiting times. Interruptions are common in this setting and are linked to error. Little is known about how they cause harm, for whom, and under what conditions.
MethodsQualitative 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 the Framework Method, informed by Cognitive Load Theory and Social Identity Theory, with independent double coding of 10% of transcripts and participant validation.
ResultsWe developed four themes. (1) Interruptions as a structural and increasingly ambiguous feature of clinical work. Interruptions were a normal part of clinical coordination, but new communication channels lacked shared norms about urgency, so each doctor had to judge what mattered. (2) The hidden cognitive cost of interruptions. The main cost came from returning to the interrupted task. This cost grew with complexity and was only partly offset by experience. (3) The social fabric of interruption burden. Transient teams weakened the norms that regulate interrupting, and approachability and hierarchy concentrated the burden on particular doctors. (4) The social amplification of cognitive burden. Understaffing multiplied cognitive costs. Doctors used familiarity and track record to decide which requests deserved attention, so concerns from junior or unfamiliar colleagues risked being discounted.
ConclusionsInterruptions are structural, and their impact depends on cognitive and social conditions. Reducing interruption frequency alone may miss the main risk. Interventions should support task resumption, protect capacity at busy times, rebuild shared communication norms and take account of the receivers capacity when designing escalation.
WHAT IS ALREADY KNOWN ON THIS TOPICInterruptions are common in clinical work and are linked to error, and laboratory studies place much of their cost in resuming the interrupted task.
WHAT THIS STUDY ADDSIn UK hospital outpatient departments, doctors accounts were consistent with these known mechanisms and suggest two further ones. Unfamiliar teams add cognitive load because each request has to be judged on its content, and under pressure, concerns raised by junior or unfamiliar colleagues may be discounted by the person receiving them.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICYInterventions should support task resumption, set shared norms about urgency, protect doctors capacity at busy times and design escalation with the receivers capacity in mind.
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BibTeX
@misc{boustani2026carries,
title = {{Who carries the cost of interruptions? A qualitative study of doctors in UK hospital outpatient departments}},
author = {S. Boustani and C. Staras and A. Rich and A. Griffin},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.11.26365196},
url = {https://www.medrxiv.org/content/10.64898/2026.10.11.26365196v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Who carries the cost of interruptions? A qualitative study of doctors in UK hospital outpatient departments
AU - S. Boustani
AU - C. Staras
AU - A. Rich
AU - A. Griffin
PY - 2026
DA - 2026/10/11
PB - medRxiv
DO - 10.64898/2026.10.11.26365196
UR - https://www.medrxiv.org/content/10.64898/2026.10.11.26365196v1
AB - BackgroundHospital outpatient departments (OPDs) deliver specialist care at scale, under close scrutiny over waiting times. Interruptions are common in this setting and are linked to error. Little is known about how they cause harm, for whom, and under what conditions. MethodsQualitative 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 the Framework Method, informed by Cognitive Load Theory and Social Identity Theory, with independent double coding of 10% of transcripts and participant validation. ResultsWe developed four themes. (1) Interruptions as a structural and increasingly ambiguous feature of clinical work. Interruptions were a normal part of clinical coordination, but new communication channels lacked shared norms about urgency, so each doctor had to judge what mattered. (2) The hidden cognitive cost of interruptions. The main cost came from returning to the interrupted task. This cost grew with complexity and was only partly offset by experience. (3) The social fabric of interruption burden. Transient teams weakened the norms that regulate interrupting, and approachability and hierarchy concentrated the burden on particular doctors. (4) The social amplification of cognitive burden. Understaffing multiplied cognitive costs. Doctors used familiarity and track record to decide which requests deserved attention, so concerns from junior or unfamiliar colleagues risked being discounted. ConclusionsInterruptions are structural, and their impact depends on cognitive and social conditions. Reducing interruption frequency alone may miss the main risk. Interventions should support task resumption, protect capacity at busy times, rebuild shared communication norms and take account of the receivers capacity when designing escalation. WHAT IS ALREADY KNOWN ON THIS TOPICInterruptions are common in clinical work and are linked to error, and laboratory studies place much of their cost in resuming the interrupted task. WHAT THIS STUDY ADDSIn UK hospital outpatient departments, doctors accounts were consistent with these known mechanisms and suggest two further ones. Unfamiliar teams add cognitive load because each request has to be judged on its content, and under pressure, concerns raised by junior or unfamiliar colleagues may be discounted by the person receiving them. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICYInterventions should support task resumption, set shared norms about urgency, protect doctors capacity at busy times and design escalation with the receivers capacity in mind.
ER -