Creating a culture of safety and respect through professional accountability: case study of the Ethos program across eight Australian hospitals

Abstract

Behaviour that is disrespectful towards others occurs frequently in hospitals, negatively impacts staff, and may undermine patient care. Professional accountability programs may address unprofessional behaviour by staff. This article examines a whole-of-hospital program, Ethos, developed by St Vincent’s Health Australia to address unprofessional behaviour, encourage speaking up, and improve organisational culture. Ethos consists of a bundle of tools, training, and resources, including an online system where staff can make submissions regarding their co-workers’ exemplary or unprofessional behaviour. Informal feedback is provided to the subject of the submission to recognise or encourage reflection on their behaviour. Following implementation in eight St Vincent’s Health Australia hospitals, the Ethos Messaging System has had 2497 submissions, 54% about positive behaviours. Peer messengers who deliver ‘Feedback for Reflection’ have faced practical challenges in providing feedback. Guidelines for the team who ‘triage’ Ethos messages have been revised to ensure only feedback that will promote reflection is passed on. Early evidence suggests Ethos has positively impacted staff, although evaluation is ongoing. The COVID-19 pandemic has required some adaptations to the program.

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

“…Approximately 2 years prior to the pandemic, these five hospitals had implemented a professional accountability culture change programme, Ethos, which may have contributed to increased resilience of staff and influenced staff behaviours during the pandemic. 19 The Ethos programme includes an emphasis on speaking‐up skills and a system for delivering peer feedback to staff about behaviours for reflection and recognition. The likely contribution of the Ethos programme to our findings is not clear.…”

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

“…Mannion et al (2019) referred to this as addressing problems at the level of bad cellars (organisa�ons), bad barrels (health systems) and bad orchards (professions) rather than the usual 'bad apples' [56]. Professional accountability programmes, such as Ethos in Australia, and Vanderbilt in the USA, show promise in fostering this kind of culture change [137,157].…”

Hospital staff reports of coworker positive and unprofessional behaviours across eight hospitals: who reports what about whom?

“…Interventions to foster positive workplace culture and reduce unprofessional behaviours in healthcare settings include professional accountability programmes,17–20 promotion of speaking up behaviours that give voice to concerns about coworker behaviours and safety,5 21 22 and staff recognition programmes which encourage peer recognition and reinforcement of positive behaviours 3 23…”

“…Built on the principle that all staff and patients should feel welcome, valued and safe, St Vincent’s Health Australia (SVHA) developed the Ethos programme, a whole of hospital professional accountability and culture change programme 11 19 35 36. The programme comprises several elements, including training staff to identify and speak up directly about unprofessional behaviours, as well as the recognition and reward of positive staff behaviours, while aiming to respond quickly and consistently to staff behaviours that fall below the expectations of the organisation 11 19 35 36. A key component of the Ethos programme is an online messaging system, which allows all staff to submit messages related to both positive and unprofessional behaviours of coworkers.…”