From Collaborative to Spread: Scaling a Standardised Patient Greeting Protocol Across a National Primary Care System in Qatar

Abstract Objectives Greeting is a foundational element of clinical communication, yet it is rarely formalized as a measurable practice in primary care. This study evaluated the implementation and scaling of a standardised welcoming and greeting protocol across a national primary care system, and assessed whether comparable improvements were achievable under a lower-resource spread model. Methods A quasi-experimental, pre-post mixed-methods evaluation was conducted across 29 primary health centres in two sequential phases: Phase 1 through a quality improvement collaborative with external expert support (19 centres), and Phase 2 through a lower-resource spread model led by trained champions and patient engagement specialists (10 centres). The protocol was co-designed with patients who participated in discovery focus groups, served as core project team members, and contributed to spread planning. Patient satisfaction with greeting was measured using a 5-point Likert scale survey, and free-text responses were analysed thematically. Results Site-level satisfaction increased significantly across all four staff groups in both phases (Phase 1: all P ≤ .012, r_rb ≥ 0.73; Phase 2: all P ≤ .023, r_rb ≥ 0.84). The largest gains occurred in Phase 2 centres, which had lower baselines: median administration satisfaction improved from 80.5% to 95.0% (+14.5 pp) and nursing from 92.0% to 98.0% (+6.0 pp). Qualitative findings mirrored these trends: positive comments about warmth and staff interaction increased substantially in Phase 1 and remained stable in Phase 2, while negative communication-related comments declined in both phases. Residual negative feedback was primarily directed at reception staff, indicating that consistency across all frontline roles remains a challenge. Conclusion These findings demonstrate that formalizing greeting as a clinical communication practice, rather than an assumed courtesy, is a feasible and scalable approach to enhancing person-centred care, and that local capacity built through a collaborative can sustain and extend improvements without continued external investment