The impact of vulnerability and exposure to pervasive interprofessional incivility among medical staff on wellbeing

Pavithra, Antoinette; Mannion, Russell; Li, Ling; Westbrook, Johanna I.

doi:10.3389/fpubh.2023.1168978

“…Nearly one-third of the participants in our study reported bullying and feeling discriminated, and although there no studies specifically looking into this phenomenon particularly among our target population, there is recent systematic review of studies involving nursing students which reported workplace bullying as high as 58.2% and discrimination in the form of racism being 12.2% ( 30 ). Another study in Australia, identified uncivil and unprofessional behaviors experience by all medical staff including doctors, nurses, paramedical and support staff at workplace to be high which impacted on their wellbeing ( 31 ). Our study showed that bullying/harassment had negative impact on participants but this association did not reach statistical significance ( p = 0.063) while experiencing discrimination did not have any impact on burnout.…”

Section: Discussionmentioning

confidence: 99%

Burnout among diabetes specialist registrars across the United Kingdom in the post-pandemic era

Agha,

Basu,

Anwar

et al. 2024

Front. Med.

2

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IntroductionBurnout syndrome is a condition resulting from chronic work-related stress exposure and can be identified by the presence of one or more of the three classic dimensions of burnout, i.e., emotional exhaustion, depersonalization, and lack of personal accomplishment, which negatively impact physician health and productivity.ObjectiveThis study aimed to identify burnout among Diabetes and Endocrinology Specialty Training Registrars (DStRs) across the United Kingdom.Design/settingIt was a Cross-sectional observational study after ethical approval ERSC_2022_1166, utilizing the gold standard Maslach Burnout Inventory to measure burnout syndrome, and to determine self-reported stressors and compare them with the results of our previous survey in 2018.ParticipantsOver 430 DStRs across the United Kingdom were invited electronically through their deanery representatives and specialty training bodies.ResultsUsing Google Forms™ to gather data, we were able to collect 104 completed surveys. Results revealed that 62.5% (n = 65) of participants have burnout (5% increase from the previous survey in 2018), 38.6% (n = 40) have high emotional exhaustion, and 44.2% (n = 46) feel a lack of personal accomplishment. “General Internal Medicine specific workload” was the most common self-reported stressor reported by 87.5% (n = 91) of participants, whereas bullying/harassment and discrimination at work were reported by 35.6% (n = 37) and 30.77% (n = 32) of participants, respectively. Using multivariable logistic regression model, personal stress (OR, 4.00; 95% CI, 1.48–10.86; p = 0.006) had significant, while Bullying/harassment (OR, 3.75; 95% CI, 0.93–15.12; p = 0.063) had marginal impact on the presence of burnout.ConclusionDiabetes and Endocrinology Specialty Training Registrars frequently experience burnout syndrome, which has increased over the last 4 years. However, organizational changes can help identify, prevent, and treat physician burnout.Trial registrationNCT05481021 available at https://ichgcp.net/clinical-trials-registry/NCT05481021.

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“…Recent research suggests that vulnerability to UB (i.e. likelihood of nega�ve impact to wellbeing) among doctors increases with greater exposure to UB, being female, and under 55 years of age [32]. The group most affected by UB, and why this may be the case, are outlined in this sec�on.…”

Section: Who Is Most Affected By Ub?mentioning

confidence: 94%

“…Experiencing UB has been associated with a greater incidence of burnout [30], inten�on to leave and absences from work [31], and in severe cases, suicidal idea�on [22]. An analysis of survey data from 512 medical staff in seven Australian hospitals found staff who were exposed to rudeness more frequently became more vulnerable to it, and that being a woman, working at a public hospital, or having a lower professional status, could worsen this vulnerability [32]. Individuals bear the brunt of the impact of UB, yet, cumula�vely, these impacts also affect the organisa�ons in which they work.…”

Section: Introduc�onmentioning

confidence: 99%

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

Aunger*,

Maben*,

Abrams

et al. 2023

Preprint

0

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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 blamed 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 *Justin Avery Aunger and Jill Maben should be considered joint first author.

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“…Recent research suggests that vulnerability to UB (i.e. likelihood of negative impact to wellbeing) among doctors increases with greater exposure to UB, being female, and under 55 years of age (32).…”

Section: How Do Unprofessional Behaviours Impact Patient Safety?mentioning

confidence: 99%

“…Experiencing UB has been associated with a greater incidence of burnout (30), intention to leave and absences from work (31), and in severe cases, suicidal ideation (21). An analysis of survey data from 512 medical staff in seven Australian hospitals found staff who were exposed to rudeness more frequently became more vulnerable to it, and that being a woman, working at a public hospital, or having a lower professional status, could worsen this vulnerability (32). Individuals bear the brunt of the impact of UB, yet cumulatively, these impacts also affect the organisations in which they work.…”

Section: Introductionmentioning

confidence: 99%

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

Aunger,

Maben,

Abrams

et al. 2023

Preprint

View full text Add to dashboard Cite

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 blamed 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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The impact of vulnerability and exposure to pervasive interprofessional incivility among medical staff on wellbeing

Cited by 4 publications

References 33 publications

Burnout among diabetes specialist registrars across the United Kingdom in the post-pandemic era

Burnout among diabetes specialist registrars across the United Kingdom in the post-pandemic era

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

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

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