Unprofessional behaviours experienced by hospital staff: qualitative analysis of narrative comments in a longitudinal survey across seven hospitals in Australia

Abstract

Background Unprofessional behaviours of healthcare staff have negative impacts on organisational outcomes, patient safety and staff well-being. The objective of this study was to undertake a qualitative analysis of narrative responses from the Longitudinal Investigation of Negative Behaviours survey (LION), to develop a comprehensive understanding of hospital staff experiences of unprofessional behaviours and their impact on staff and patients. The LION survey identified staff experiences and perceptions related to unprofessional behaviours within hospitals. Methods Two open-ended questions within the LION survey invited descriptions of unprofessional staff behaviours across seven hospitals in three Australian states between December 2017 and November 2018. Respondents were from medical, nursing, allied health, management, and support services roles in the hospitals. Data were qualitatively analysed using Directed Content Analysis (DCA). Results From 5178 LION survey responses, 32% (n = 1636) of participants responded to the two open-ended questions exploring staff experiences of unprofessional behaviours across the hospital sites surveyed. Three primary themes and 11 secondary themes were identified spanning, i) individual unprofessional behaviours, ii) negative impacts of unprofessional behaviours on staff well-being, psychological safety, and employee experience, as well as on patient care, well-being, and safety, and iii) organisational factors associated with staff unprofessional behaviours. Conclusion Unprofessional behaviours are experienced by hospital staff across all professional groups and functions. Staff conceptualise, perceive and experience unprofessional behaviours in diverse ways. These behaviours can be understood as enactments that either negatively impact other staff, patients or the organisational outcomes of team cohesion, work efficiency and efficacy. A perceived lack of organisational action based on existing reporting and employee feedback appears to erode employee confidence in hospital leaders and their ability to effectively address and mitigate unprofessional behaviours.

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

“…The consequences of these behaviours on the well‐being of individuals are substantial 3–5 . Evidence is also emerging of the effects on quality of care and patient outcomes 6 .…”

“…3 The consequences of these behaviours on the well-being of individuals are substantial. [3][4][5] Evidence is also emerging of the effects on quality of care and patient outcomes. 6 Multiple simulation studies in different countries have shown that clinical teams and individuals exposed to unprofessional behaviours perform significantly worse on a range of metrics, from diagnostic performance to clinical vigilance.…”

Nurses' perceptions of quality of work life in private hospitals in Enugu, Nigeria: A qualitative study

“…Nurses' QWL is defined as “the degree to which registered nurses are able to satisfy important personal needs through their experiences in their work organization while achieving the organization's goals” [5] . QWL posits that people are the most critical resource in an organization and should be treated with dignity and respect [6] , [7] . QWL focuses on workplace improvement based on a dual agenda of employee well-being and organizational performance [6] .…”

“…QWL posits that people are the most critical resource in an organization and should be treated with dignity and respect [6] , [7] . QWL focuses on workplace improvement based on a dual agenda of employee well-being and organizational performance [6] . An improved QWL is essential to recruit and retain nurses, increase their productivity and organizational commitment, enhance effectiveness of the patient care system and ensure greater patient satisfaction [8] – [11] .…”

“…Work design encompasses the actual work nurses do and how the immediate work environment, such as autonomy at work, the workload and human resource availability; the time to do a job, non-nursing tasks and receiving assistance at work affect the well-being of nurses and organizational performance [5] . Evidence indicates that an excessive workload [3] , [8] , [18] – [20] , lack of staff [19] , [21] – [23] , long work hours [24] , [25] , weekend schedules [24] , emotional exhaustion [18] , [26] , conflicting priorities and diffuse responsibilities [6] and a lack of autonomy [23] negatively impact the quality of nursing work life. Nurses assumed various non-nursing roles at different levels, backstopping other health professionals to offer the best to their patients and their organization [8] , [27] .…”