Interventions to address unprofessional behaviours between staff in acute care: what works for whom and why? A realist review

BMC Medicine

Research Article

Johanna I. Westbrook¹  Russell Mannion²  Jill Maben³  Ruth Abrams³  Justin Avery Aunger⁴  Judy M. Wright⁵  Aled Jones⁶  Mark Pearson⁷ 

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

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

[3]School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK

[4]School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK

[5]NIHR Midlands Patient Safety Research Collaboration, University of Birmingham, Birmingham, UK

[6]Institute of Applied Health Research, University of Birmingham, Birmingham, UK

[7]School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK

[8]School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK

[9]Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK

关键词: Professionalism;    Unprofessional behaviour;    Patient safety;    Psychological wellbeing;    Psychological safety;    Incivility;    Organisational culture;    Bullying;    Workforce;    Acute healthcare;   

DOI  :  10.1186/s12916-023-03102-3

 received in 2023-07-11, accepted in 2023-10-04,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundUnprofessional behaviour (UB) between staff encompasses various behaviours, including incivility, microaggressions, harassment, and bullying. UB is pervasive in acute healthcare settings and disproportionately impacts minoritised staff. UB has detrimental effects on staff wellbeing, patient safety and organisational resources. While interventions have been implemented to mitigate UB, there is limited understanding of how and why they may work and for whom.MethodsThis study utilised a realist review methodology with stakeholder input to improve understanding of these complex context-dependent interventions. Initial programme theories were formulated drawing upon scoping searches and reports known to the study team. Purposive systematic searches were conducted to gather grey and published global literature from databases. Documents were selected if relevant to UB in acute care settings while considering rigour and relevance. Data were extracted from these reports, synthesised, and initial theories tested, to produce refined programme theories.ResultsOf 2977 deduplicated records, 148 full text reports were included with 42 reports describing interventions to address UB in acute healthcare settings. Interventions drew on 13 types of behaviour change strategies and were categorised into five types of intervention (1) single session (i.e. one off); (2) multiple session; (3) single or multiple sessions combined with other actions (e.g. training sessions plus a code of conduct); (4) professional accountability and reporting programmes and; (5) structured culture change interventions. We formulated 55 context-mechanism-outcome configurations to explain how, why, and when these interventions work. We identified twelve key dynamics to consider in intervention design, including importance of addressing systemic contributors, rebuilding trust in managers, and promoting a psychologically safe culture; fifteen implementation principles were identified to address these dynamics.ConclusionsInterventions to address UB are still at an early stage of development, and their effectiveness to reduce UB and improve patient safety is unclear. Future interventions should incorporate knowledge from behavioural and implementation science to affect behaviour change; draw on multiple concurrent strategies to address systemic contributors to UB; and consider the undue burden of UB on minoritised groups.Study registrationThis study was registered on the international database of prospectively registered systematic reviews in health and social care (PROSPERO): https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021255490.

【 授权许可】

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

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