Changes in unprofessional behaviour, teamwork and co‐operation among hospital staff during the COVID‐19 pandemic

Westbrook, Johanna I.; McMullan, Ryan; Urwin, Rachel; Churruca, Kate; Metri, Joelle; Loh, Erwin; Li, Ling

doi:10.1111/imj.15913

Cited by 4 publications

(2 citation statements)

References 19 publications

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“…The study was conducted during the COVID-19 pandemic exacerbating recruitment difficulties. However, COVID was not a primary source for UBs in this study’s settings[ 50 ]. Finally, we did not include all hospitals using the Ethos program, which had been established for varying periods across the participating hospitals (2–3 years).…”

Section: Discussionmentioning

confidence: 99%

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

Bagot,

McInnes,

Mannion

et al. 2023

BMC Health Serv Res

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Background The 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. Methods Qualitative, 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. Results Thirty 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). Conclusions Addressing 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.

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Section: Discussionmentioning

confidence: 99%

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

Bagot,

McInnes,

Mannion

et al. 2023

BMC Health Serv Res

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“…A cross-sectional survey was conducted as part of a larger program of research evaluating the Ethos program. 8,[12][13][14] The project was approved by the Human Research Ethics Committee of St Vincent's Hospital Melbourne (HREC/17/ SVHM/237).…”

Section: Methodsmentioning

confidence: 99%

Experiences of peer messengers as part of a professional accountability culture change program to reduce unprofessional behaviour: a cross-sectional study across eight hospitals

et al. 2023

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Objective Professional accountability programs are designed to promote professional behaviours between co-workers and improve organisational culture. Peer messengers play a key role in professional accountability programs by providing informal feedback to hospital staff about their behaviour. Little is known about the experiences of messengers. This study examined the experiences of staff who delivered messages to peers as part of a whole-of-hospital professional accountability program called ‘Ethos’. Methods Ethos messengers (EMs) across eight Australian hospitals were invited to complete an online survey. The survey consisted of 17 close-ended questions asking respondents about their experiences delivering messages to peers and their perceptions of the Ethos program. Four open-ended questions asked respondents about rewarding and challenging aspects of being a peer messenger and what they would change about the program. Results Sixty EMs provided responses to the survey (response rate, 41.4%). The majority were from nursing and medical groups (53.4%) and had delivered 1–5 messages to staff (57.7%). Time as an EM ranged from less than 3 months to more than 12 months. A majority had been an EM for more than 12 months (80%; n = 40). Most agreed they had received sufficient training for the role (90.1%; n = 48) and had the skills (90.1%; n = 48), access to support (84.9%; n = 45) and time to fulfil their responsibilities (70.0%; n = 30). Approximately a third (34.9%; n = 15) of respondents indicated that recipients were ‘sometimes’ or ‘never’ receptive to messages. Challenging aspects of the role included organising a time to talk with staff, delivering feedback effectively and communicating with peers who lacked insight and were unable to reflect on their behaviour. Conclusions Skills development for peer messengers is key to ensuring the effectiveness and sustainability of professional accountability programs. Training in how to deliver difficult information and respond to negative reactions to feedback was identified by EMs as essential to support their ongoing effectiveness in their role.

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Staff Opinions on the Most Positive and Negative Changes in Mental Health Services During the 2 Years of the Pandemic Emergency in Italy

Magliano,

Papa,

Di Maio

et al. 2024

J. Psychosoc. Rehabil. Ment. Health

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This mixed-methods study investigated healthcare staff members’ opinions on the most positive and negative changes in mental health services (MHSs) during the 2-year COVID-19 pandemic emergency in Italy, and whether those changes differed by professional role and type of service. At the end of the national health emergency (March–April 2022), staff members from 17 MHSs completed the MHS Transformations Questionnaire, which includes a quantitative section with 30 multiple-choice items addressing positive changes and a qualitative section with two open-ended items on the most positive and negative changes. The 714 participants who responded to at least one open-ended item in the qualitative section formed the sample. Qualitative responses were categorised according to the textual content of the response and the themes of the quantitative section. Flexibility and Ability to Reinvent the Service was the subscale with the highest mean score. The most positive and negative changes fell into the following categories: practices (49.1 and 39%), organisation (34.5 and 36.9%), teamwork values (45.0 and 34.5%), and relationships with users and their families (31.9 and 40.6%). The most positive changes differed by type of service (i.e. in the relationship with users and their families category) and by professional role (i.e. in the practices and relationship with users and their families categories), whereas the most negative changes differed by type of service (i.e. in the practices category). The results may elucidate the complex experiences with the COVID-19 pandemic in MHSs and reveal lessons to be considered in post-pandemic service planning.

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Changes in unprofessional behaviour, teamwork and co‐operation among hospital staff during the COVID‐19 pandemic

Cited by 4 publications

References 19 publications

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

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

Experiences of peer messengers as part of a professional accountability culture change program to reduce unprofessional behaviour: a cross-sectional study across eight hospitals

Staff Opinions on the Most Positive and Negative Changes in Mental Health Services During the 2 Years of the Pandemic Emergency in Italy

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