Why we should avoid handover hostility

Al-Rais, Andrew

doi:10.1136/bmj.j1272

BMJ

2017

DOI: 10.1136/bmj.j1272

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Why we should avoid handover hostility

Andrew Al-Rais¹

Abstract: No patient has died from lack of manners, but rudeness among staff can affect performance

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Cited by 3 publications

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“…Handover hostility is an ongoing problem in the NHS and detrimental to both patient care and doctors' wellbeing. 5,6 This letter is not meant to demand doctors constantly work overtime to finish their jobs. It is a gentle reminder to revisit some key bioethics concepts -act in the patient's best interest and do no harm.…”

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confidence: 99%

When the words ‘handover’ and ‘prioritise’ are overused

Yeung

2017

Br J Gen Pract

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mentioning

confidence: 99%

When the words ‘handover’ and ‘prioritise’ are overused

Yeung

2017

Br J Gen Pract

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Drivers of unprofessional behaviour between staff in acute care hospitals: a realist review

Aunger,

Maben,

Abrams

et al. 2023

BMC Health Serv Res

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Background Unprofessional behaviours (UB) between healthcare staff are rife in global healthcare systems, negatively impacting staff wellbeing, patient safety and care quality. Drivers of UBs include organisational, situational, team, and leadership issues which interact in complex ways. An improved understanding of these factors and their interactions would enable future interventions to better target these drivers of UB. Methods A realist review following RAMESES guidelines was undertaken with stakeholder input. Initial theories were formulated drawing on reports known to the study team and scoping searches. A systematic search of databases including Embase, CINAHL, MEDLINE and HMIC was performed to identify literature for theory refinement. Data were extracted from these reports, synthesised, and initial theories tested, to produce refined programme theories. Results We included 81 reports (papers) from 2,977 deduplicated records of grey and academic reports, and 28 via Google, stakeholders, and team members, yielding a total of 109 reports. Five categories of contributor were formulated: (1) workplace disempowerment; (2) harmful workplace processes and cultures; (3) inhibited social cohesion; (4) reduced ability to speak up; and (5) lack of manager awareness and urgency. These resulted in direct increases to UB, reduced ability of staff to cope, and reduced ability to report, challenge or address UB. Twenty-three theories were developed to explain how these contributors work and interact, and how their outcomes differ across diverse staff groups. Staff most at risk of UB include women, new staff, staff with disabilities, and staff from minoritised groups. UB negatively impacted patient safety by impairing concentration, communication, ability to learn, confidence, and interpersonal trust. Conclusion Existing research has focused primarily on individual characteristics, but these are inconsistent, difficult to address, and can be used to deflect organisational responsibility. We present a comprehensive programme theory furthering understanding of contributors to UB, how they work and why, how they interact, whom they affect, and how patient safety is impacted. More research is needed to understand how and why minoritised staff are disproportionately affected by UB. Study registration This 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.

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

Maben,

Aunger,

Abrams

et al. 2023

BMC Med

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Background Unprofessional 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. Methods This 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. Results Of 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. Conclusions Interventions 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 registration This 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.

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Why we should avoid handover hostility

Abstract: No patient has died from lack of manners, but rudeness among staff can affect performance

Cited by 3 publications

References 2 publications

When the words ‘handover’ and ‘prioritise’ are overused

When the words ‘handover’ and ‘prioritise’ are overused

Drivers of unprofessional behaviour between staff in acute care hospitals: a realist review

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

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