Why do acute healthcare staff engage in unprofessional behaviours towards each other and how can these behaviours be reduced? A realist review protocol

Maben, Jill; Aunger, Justin Avery; Abrams, Ruth; Pearson, Mark; Wright, Judy; Westbrook, Johanna I.; Mannion, Russell; Jones, Aled

doi:10.1136/bmjopen-2022-061771

“…This review followed the Realist and Meta-Review Evidence Synthesis: Evolving Standards (RAMESES) publication standards (42). The protocol for this review has been previously peer reviewed and published (43).…”

Section: Methodsmentioning

confidence: 99%

“…Since publication of our study protocol, there have been no signi cant changes, other than renaming causes to contributors to re ect that these relationships are often not fully deterministic (43). Where exibility was built into our protocol (e.g., with our relevancy criteria), the reporting of methods in this paper has been updated to re ect which criteria we drew upon in the selection of documents.…”

Section: Changes To Methodology In the Study Protocolmentioning

confidence: 99%

“…By drawing on a realist review methodology, we aimed to build an understanding of how and why various contributors lead to UB, how these contributors interact, and how UB leads to negative impacts on patients and staff. We intended for these ndings to enable the design of better interventions to target contributors to UB in healthcare workplaces (35).…”

Section: Introductionmentioning

confidence: 99%

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

Aunger,

Maben,

Abrams

et al. 2023

Preprint

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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.

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“…This review followed the Realist and Meta-Review Evidence Synthesis: Evolving Standards (RAMESES) publica�on standards [42]. The protocol for this review has been previously peer reviewed and published [43]. A RAMESES checklist is available in Addi�onal File 1.…”

Section: Ra�onale For and Use Of Realist Methodsmentioning

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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“…Although not always recognized, healthcare as an industry is predisposed to harassment (1)(2)(3)(4). In some cases, this may be related to differences in economic status, prestige and power (5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Harassment in the headache field: a global web-based cross-sectional survey

de Boer,

Ambrosini,

Halker Singh

et al. 2023

Cephalalgia

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Background Matters of workplace harassment are an important issue. This issue needs to be recognized and studied to prevent occurrences. These important sensitive areas of effective workplace management are increasingly gaining more interest. We aimed to identify the prevalence of workplace sexual, verbal and physical harassment among headache professionals. Methods We adopted a cross‑sectional exploratory survey approach with quantitative design. The survey was distributed electronically among headache healthcare and research professionals globally through the International Headache Society (IHS). Results Data were obtained from 579 respondents (55.3%; 320/579 women). A large percentage of respondents (46.6%; 270/579) had experienced harassment; specifically, 16.1% (93/578) reported sexual harassment, 40.4% (234/579) verbal harassment and 5.5% (32/579) physical harassment. Women were almost seven times more likely to experience sexual harassment compared to men (odds ratio = 6.8; 95% confidence interval = 3.5–13.2). Although women did also more frequently report other types of harassment, this was not statistically significant (odds ratio = 1.4; 95% confidence interval = 1.0–2.0). Conclusions Lifetime exposure to workplace harassment is prevalent among headache professionals, especially in women. The present study uncovers a widespread issue and calls for strategies to be implemented for building a healthy and safe workplace environment.

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Why do acute healthcare staff engage in unprofessional behaviours towards each other and how can these behaviours be reduced? A realist review protocol

Cited by 7 publications

References 53 publications

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

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

Harassment in the headache field: a global web-based cross-sectional survey

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