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

Abstract

BackgroundWorkplace behaviours of healthcare staff impact patient safety, staff well-being and organisational outcomes. A whole-of-hospital culture change programme, Ethos, was implemented by St. Vincent’s Health Australia across eight hospitals. Ethos includes a secure online submission system that allows staff across all professional groups to report positive (Feedback for Recognition) and negative (Feedback for Reflection) coworker behaviours. We analysed these submissions to determine patterns and rates of submissions and identify the coworker behaviours reported.MethodAll Ethos submissions between 2017 and 2020 were deidentified and analysed. Submissions include structured data elements (eg, professional role of the reporter and subjects, event and report dates) and a narrative account of the event and coworker behaviours. Descriptive statistics were calculated to assess use and reporting patterns. Coding of the content of submissions was performed to classify types of reported coworker behaviours.ResultsThere were a total of 2504 Ethos submissions, including 1194 (47.7%) Recognition and 1310 (52.3%) Reflection submissions. Use of the submission tool was highest among nurses (20.14 submissions/100 nursing staff) and lowest among non-clinical services staff (5.07/100 non-clinical services staff). Nurses were most frequently the subject of Recognition submissions (7.56/100 nurses) while management and administrative staff were the least (4.25/100 staff). Frequently reported positive coworker behaviours were non-technical skills (79.3%, N=947); values-driven behaviours (72.5%, N=866); and actions that enhanced patient care (51.3%, N=612). Medical staff were the most frequent subjects of Reflection submissions (12.59/100 medical staff), and non-clinical services staff the least (4.53/100 staff). Overall, the most frequently reported unprofessional behaviours were being rude (53.8%, N=705); humiliating or ridiculing others (26%, N=346); and ignoring others’ opinions (24.6%, N=322).ConclusionHospital staff across all professional groups used the Ethos messaging system to report both positive and negative coworker behaviours. High rates of Recognition submissions demonstrate a strong desire of staff to reward and encourage positive workplace behaviours, highlighting the importance of culture change programmes which emphasise these behaviours. The unprofessional behaviours identified in submissions are consistent with behaviours previously reported in surveys of hospital staff, suggesting that submissions are a reliable indicator of staff experiences.

Evaluation of a culture change program to reduce unprofessional behaviours by hospital co-workers in Australian hospitals

“…We compared the characteristics of the baseline and follow-up samples, adjusted for these factors, and undertook subgroup analyses with and without medical respondents for the key outcomes to assess the impact on the results. In our analysis of Ethos submissions across eight hospitals [ 28 ], we found similar rates of use of the Ethos reporting system (14.1 submissions/100 staff) as reported by those who responded to the survey, which indicates survey respondents had similar levels of engagement with the Program. The most frequent unprofessional behaviours reported to the messaging system were consistent with the most frequent behaviours reported in the staff surveys.…”

“…Our evaluation of the online messages showed that clinical staff had the highest rates of using the online messaging system. However, all professional groups submitted Ethos messages about unprofessional behaviours at roughly equal inter- and intra-professional rates, which is not surprising given the multidisciplinary nature of healthcare [ 28 ]. The reason we found the greatest decline in unprofessional behaviours experienced by non-clinical and managerial staff may be related to the fact that these groups had not previously been incorporated into targeted programs to reduce unprofessional behaviours.…”

“…We designed a multi-component evaluation program to assess the use, challenges and effects of the Ethos Program [ 24 , 26 , 27 ]. This evaluation included detailed analysis of the reports submitted by staff to the Ethos messaging system [ 28 ], which revealed widespread use of the system by all professional groups both for recognising positive and reporting unprofessional behaviour for reflection. Analysis of 2504 submissions showed 47.7% were for recognition and 52.3% for reflection.…”

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

“…The 1310 feedback for reflection submissions had previously been coded for 26 unprofessional behaviours, described elsewhere [ 16 ]. This process involved four researchers independently coding 10% of the reflection submissions to assess consistency.…”