Co-worker unprofessional behaviour and patient safety risks: an analysis of co-worker reports across eight Australian hospitals

Abstract

Background: A key component of professional accountability programs is online reporting tools that allow hospital staff to report co-worker unprofessional behaviour. Few studies have analysed data from these systems to further understand the nature or impact of unprofessional behaviour amongst staff. Ethos is a whole-of-hospital professional accountability program that includes an online messaging system. Ethos has now been implemented across multiple Australian hospitals. This study examined reported unprofessional behaviour that staff indicated created a risk to patient safety. Methods: This study included 1310 Ethos submissions reporting co-worker unprofessional behaviour between 2017-2020 across eight Australian hospitals. Submissions that indicated the behaviour increased the risk to patient safety were identified. Descriptive summary statistics were presented for reporters and subjects of submissions about unprofessional behaviour. Logistic regression was applied to examine the association between each unprofessional behaviour (of the six most frequently reported in the Ethos submissions) and patient safety risk reported in the submissions. The descriptions in the reports were reviewed and the patient safety risks were coded using a framework aligned with the World Health Organisation’s International Classification for Patient Safety. Results: Of 1310 submissions about unprofessional behaviour, 395 (30.2%) indicated there was a risk to patient safety. Nurses made the highest number of submissions that included a patient safety risk (3.47 submissions per 100 nursing staff, 95%CI:3.09-3.9) compared to other professional groups. Medical professionals had the highest rate as subjects of submissions for unprofessional behaviour with a patient safety risk (5.19 submissions per 100 medical staff, 95%CI:4.44-6.05). ‘Opinions being ignored’ (odds ratio: 1.68; 95%CI:1.23 – 2.22; p<0.001) and ‘someone withholding information which affects work performance’ were behaviours strongly associated with patient safety risk in the submissions (odds ratio: 2.50; 95%CI:1.73 – 3.62; p<0.001) compared to submissions without a patient safety risk. The two main types of risks to patient safety described were related to clinical process/procedure and clinical administration. Commonly reported events included staff not following policy or protocol; doctors refusing to review a patient; and interruptions and inadequate information during handover. Conclusion: Our findings indicate that unprofessional behaviour was associated with risks to patient safety. Co-worker reports about unprofessional behaviour have significant value as they can be used by organisations to better understand how unprofessional behaviour can disrupt work practices and lead to risks to patient safety.