Strategies to address unprofessional behaviours among staff in acute healthcare settings: a realist review

Project Description

The unprofessional behaviours of healthcare staff towards each other are known to be widespread. In poor workplace cultures such behaviours can be considered ‘normal’. Yet they significantly affect an individual’s ability to work without fear and speak up to those in authority when things are not right.
Such behaviours affect patient safety, staff experience and well-being and impact the organisations safety culture. This study builds on previous research by the team and others by focusing on unprofessional behaviours between staff groups in acute care settings (hospitals). These behaviours include rudeness, overstepping boundaries, verbal aggression, sexual and racial harassment and bullying. They affect all staff, but are more likely in certain professions such as ambulance trusts, or groups including people from black and minority ethnic groups. Current strategies to address unprofessional behaviours often focus on individuals and do not take an organisational approach. They also often focus on only one type of unprofessional behaviour. Managers and others in positions capable of implementing change do not always know what to do and which strategies are best to use with which staff groups to address specific types of behaviours. This review will provide that information.

The aim of the project is to improve understanding of how, why and in what circumstances staff unprofessional behaviours can be best reduced, managed and prevented. Specifically to understand:
(i) any differences and similarities between terms referring to unprofessional behaviours and how these terms are used by different professional groups; (ii) the circumstances (contexts) of unprofessional behaviours; (iii) how strategies to reduce unprofessional behaviours might work (mechanisms) and lead to behaviour change; and (iv) the outcomes of unprofessional behaviours on staff, patients and the wider healthcare system. We will also produce recommendations and practical resources that managers can use to prevent, manage and reduce unprofessional behaviours. We will build on these research findings to develop a follow-on intervention study to evaluate whether these strategies work when they are put into practice. We will conduct a realist review which focuses on understanding not only if interventions work (or not) but how they work, why, and for whom they work. This allows us to analyse a wider range of relevant literature (i.e. not only academic journal articles). We have formed a team with expertise in unprofessional behaviours, psychological safety and realist reviews to undertake the research. The team will search for, make sense of and synthesise the literature on this topic. We will share the findings with a stakeholder group which includes patient and public representatives as well as healthcare staff with experience of unprofessional behaviours. This group will draw on their experiences and knowledge to work with the researchers to understand the findings and will help to design and develop evidenced-based guidelines for NHS managers to reduce and prevent unprofessional behaviours. Findings will be shared via reports, academic publications and plain English summaries to reach a wide audience, including patients and the public, NHS trusts, NHS Employers, and NHS England. We will also use inventive methods share the study findings including a short film, animations, pictorial representation of our findings (info-graphics) and interactive drama performances.