Retrospective analysis of factors influencing the implementation of a program to address unprofessional behaviour and improve culture in Australian hospitals

BMC Health Services Research

Research Article

Johanna Westbrook¹  Ryan D McMullan¹  Rebecca Mitchell¹  Kate Churruca¹  Rachel Urwin¹  Neroli Sunderland¹  Peter Hibbert²  Kathleen L Bagot³  Natalie Taylor⁴  Erwin Loh⁵  Neil Cunningham⁶ 

[1] Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, 2109, NSW, Australia;Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, 2109, NSW, Australia;Allied Health and Human Performance, University of South Australia, Adelaide, Australia;Nursing Research Institute, St Vincent’s Health Australia Sydney, St Vincent’s Hospital Melbourne and Australian Catholic University, Daniel Mannix Building, Brunswick Street, Fitzroy, Australia;School of Population Health, University of New South Wales, Sydney, Australia;St Vincent’s Health Australia, Melbourne, Australia;St Vincent’s Hospital Melbourne, Fitzroy, Australia;

关键词: Unprofessional behaviour;    Professional accountability program;    Culture change;    Hospital culture;    CFIR;    Implementation determinants;    Evaluation;   

DOI  :  10.1186/s12913-023-09614-1

 received in 2022-07-13, accepted in 2023-05-24,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundUnprofessional behaviour among hospital staff is common. Such behaviour negatively impacts on staff wellbeing and patient outcomes. Professional accountability programs collect information about unprofessional staff behaviour from colleagues or patients, providing this as informal feedback to raise awareness, promote reflection, and change behaviour. Despite increased adoption, studies have not assessed the implementation of these programs utilising implementation theory. This study aims to (1) identify factors influencing the implementation of a whole-of-hospital professional accountability and culture change program, Ethos, implemented in eight hospitals within a large healthcare provider group, and (2) examine whether expert recommended implementation strategies were intuitively used during implementation, and the degree to which they were operationalised to address identified barriers.MethodData relating to implementation of Ethos from organisational documents, interviews with senior and middle management, and surveys of hospital staff and peer messengers were obtained and coded in NVivo using the Consolidated Framework for Implementation Research (CFIR). Implementation strategies to address identified barriers were generated using Expert Recommendations for Implementing Change (ERIC) strategies and used in a second round of targeted coding, then assessed for degree of alignment to contextual barriers.ResultsFour enablers, seven barriers, and three mixed factors were found, including perceived limitations in the confidential nature of the online messaging tool (‘Design quality and packaging’), which had downstream challenges for the capacity to provide feedback about utilisation of Ethos (‘Goals and Feedback’, ‘Access to Knowledge and Information’). Fourteen recommended implementation strategies were used, however, only four of these were operationalised to completely address contextual barriers.ConclusionAspects of the inner setting (e.g., ‘Leadership Engagement’, ‘Tension for Change’) had the greatest influence on implementation and should be considered prior to the implementation of future professional accountability programs. Theory can improve understanding of factors affecting implementation, and support strategies to address them.

【 授权许可】

CC BY   
© The Author(s) 2023

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