Middle manager responses to hospital co-workers’ unprofessional behaviours within the context of a professional accountability culture change program: a qualitative analysis

BMC Health Services Research

Research

P Hibbert¹  JI Westbrook¹  R Urwin¹  K Churruca¹  RD McMullan¹  R Mannion²  KL Bagot³  E McInnes⁴ 

[1]Australian Institute of Health Innovation, Macquarie University, Sydney, Australia

[2]Health Services Management Centre, University of Birmingham, Birmingham, UK

[3]Nursing Research Institute –St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne and Australian Catholic University, Fitzroy, VIC, Australia

[4]School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, VIC, Australia

[5]Nursing Research Institute –St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne and Australian Catholic University, Fitzroy, VIC, Australia

[6]School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, VIC, Australia

[7]School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Australia

关键词: Unprofessional behaviours;    Professionalism;    Organizational Culture;    Qualitative;    Professional Accountability;    Speaking up;    Hospitals;   

DOI  :  10.1186/s12913-023-09968-6

 received in 2023-06-21, accepted in 2023-08-25,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe critical role that middle managers play in enacting organisational culture change designed to address unprofessional co-worker behaviours has gone largely unexplored. We aimed to explore middle managers’ perspectives on i) whether they speak up when they or their team members experience unprofessional behaviours (UBs); ii) how concerns are handled; iii) the outcomes; and iv) the role of a professional accountability culture change program (known as Ethos) in driving change.MethodsQualitative, constructivist approach. Five metropolitan hospitals in Australia which had implemented Ethos. Purposive sampling was used to invite middle-level managers from medicine, nursing, and non-clinical support services. Semi-structured interviews conducted remotely. Inductive, reflexive thematic and descriptive thematic analyses undertaken using NVivo.ResultsThirty interviews (approximately 60 min; August 2020 to May 2021): Nursing (n = 12), Support Services (n = 10), and Medical (n = 8) staff, working in public (n = 18) and private (n = 12) hospitals. One-third (n = 10) had a formal role in Ethos.All middle managers (hearers) had experienced the raising of UBs by their team (speakers). Themes representing reasons for ongoing UBs were: staying silent but active; history and hierarchy; and double-edged swords. The Ethos program was valued as a confidential, informal, non-punitive system but required improvements in profile and effectiveness. Participants described four response stages: i) determining if reports were genuine; ii) taking action depending on the speaker’s preference, behaviour factors (type, frequency, impact), if the person was known/unknown; iii) exploring for additional information; and iv) addressing either indirectly (e.g., change rosters) or directly (e.g., become a speaker).ConclusionsAddressing UBs requires an organisational-level approach beyond supporting staff to speak up, to include those hearing and addressing UBs. We propose a new hearer’s model that details middle managers’ processes after a concern is raised, identifying where action can be taken to minimise avoidant behaviours to improve hospital culture, staff and patient safety.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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