ISQua's 40th International Conference 2024

How can unprofessional behaviours between healthcare staff be reduced? A realist review

Introduction

Unprofessional behaviours (UBs) have been defined as “any interpersonal behaviour causing distress or harm to other healthcare staff”.

Such behaviours encompass incivility, bullying, harassment and microaggressions.

Despite repeated scandals in the UK NHS and internationally, there is limited knowledge about what can be done to address UB in healthcare organisations.

We conducted a realist review [1] to understand how, why, and in what contexts interventions to reduce UBs between healthcare staff work, and whom they may benefit.

Methods

Our realist review followed this six-step methodology [3]:

(1) Formulating initial programme theories drawing on informal literature searches.
(2) Performing systematic and purposive searches for grey and peer-reviewed literature on Embase, CINAHL and MEDLINE databases as well as Google and Google Scholar.
(3) Selecting appropriate documents while considering rigour and relevance.
(4) Extracting and synthesising data.
(5) Refining the programme theories by testing the theories against identified literature and with stakeholders.
(6) Developing resources based on programme theories.

Results

•Search results: from n=2977 records, n=148 full text sources were included with n=42 sources describing interventions.

•Countries: thirty were conducted in the USA; five in Australia; two each in Canada and South Korea; and one in Turkey, Ireland, and Iran.

•Evaluations: twenty-nine out of 42 studies assessed intervention effectiveness.

•Effectiveness (reducing UB): of these 29, the majority (n = 23) reported some positive results, three reported no significant change and three reported a negative result.

•Outcome measures: the most common outcome measure was the change in the prevalence of UB following implementation of the intervention (n = 23).

•Seven studies assessed staff wellbeing or proxies such as turnover intention or burnout

•No studies assessed improvements to patient safety or economic factors.

Implications

Most interventions do not address systemic contributors to UB and rely on education or training workshops. Interventions that focus on both individual and systemic contributors are required to effectively reduce UB [4]. It is unclear whether these interventions positively impact organisational culture, patient safety or staff psychological wellbeing. Future research should (1) draw on modern behavioural and implementation science principles (2) incorporate economic analyses, (3) focus on systemic issues that produce UB and (4) address the additional burden of UB experienced by women and minoritised staff.

References:

1. Maben J, Aunger JA, Abrams R, Wright JM, Pearson M, Westbrook JI, et al. Interventions to address unprofessional behaviours between staff in acute care: What works for whom and why? A realist review. BMC Med [Internet]. 2023a;21(403). Available from: https://doi.org/10.1186/s12916-023-03102-3

2. Maben J, Aunger, Justin. A. Abrams, Ruth. Mannion R, Pearson M, Wright JM, Jones, Aled. Westbrook J. Addressing unprofessional behaviours between healthcare staff: A guide. [Internet]. Guildford: University of Surrey; 2023b. p. 1–38. Available from: workforceresearchsurrey.health

3. Pawson R, Greenhalgh T, Harvey G, Walshe K. Realist review - A new method of systematic review designed for complex policy interventions. J Heal Serv Res Policy. 2005;10(SUPPL. 1):21–34.

4. Aunger JA, Abrams R, Mannion R, Westbrook JI, Jones A, Wright JM, et al. How can interventions more directly address drivers of unprofessional behaviour between healthcare staff? BMJ Open Qual [Internet]. 2024 Jul 1;13(3):e002830. Available from: http://bmjopenquality.bmj.com/content/13/3/e002830.abstract

ISQua's 40th International Conference 2024

Why do acute healthcare staff behave unprofessionally towards each other and how can these behaviours be reduced? A realist review

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