Interventions to address unprofessional behaviours between staff in acute care: what works for whom and why? A realist review

被引:14
作者
Maben, Jill [1 ]
Aunger, Justin Avery [1 ,2 ,3 ]
Abrams, Ruth [1 ]
Wright, Judy M. [4 ]
Pearson, Mark [5 ]
Westbrook, Johanna I. [6 ]
Jones, Aled [7 ]
Mannion, Russell [8 ]
机构
[1] Univ Surrey, Sch Hlth Sci, Fac Hlth & Med Sci, Guildford, England
[2] Univ Birmingham, NIHR Midlands Patient Safety Res Collaborat, Birmingham, England
[3] Univ Birmingham, Inst Appl Hlth Res, Birmingham, England
[4] Univ Leeds, Sch Med, Fac Med & Hlth, Leeds, England
[5] Univ Hull, Hull York Med Sch, Wolfson Palliat Care Res Ctr, Kingston Upon Hull, England
[6] Macquarie Univ, Australian Inst Hlth Innovat, Sydney, NSW, Australia
[7] Univ Plymouth, Sch Nursing & Midwifery, Fac Hlth, Plymouth, England
[8] Univ Birmingham, Hlth Serv Management Ctr, Birmingham, England
关键词
Professionalism; Unprofessional behaviour; Patient safety; Psychological wellbeing; Psychological safety; Incivility; Organisational culture; Bullying; Workforce; Acute healthcare; COGNITIVE REHEARSAL PROGRAM; HEALTH-CARE; EDUCATIONAL INTERVENTION; HORIZONTAL VIOLENCE; NURSES EXPERIENCES; WORKPLACE; INCIVILITY; CIVILITY; PROFESSIONALISM; HARASSMENT;
D O I
10.1186/s12916-023-03102-3
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BackgroundUnprofessional behaviour (UB) between staff encompasses various behaviours, including incivility, microaggressions, harassment, and bullying. UB is pervasive in acute healthcare settings and disproportionately impacts minoritised staff. UB has detrimental effects on staff wellbeing, patient safety and organisational resources. While interventions have been implemented to mitigate UB, there is limited understanding of how and why they may work and for whom.MethodsThis study utilised a realist review methodology with stakeholder input to improve understanding of these complex context-dependent interventions. Initial programme theories were formulated drawing upon scoping searches and reports known to the study team. Purposive systematic searches were conducted to gather grey and published global literature from databases. Documents were selected if relevant to UB in acute care settings while considering rigour and relevance. Data were extracted from these reports, synthesised, and initial theories tested, to produce refined programme theories.ResultsOf 2977 deduplicated records, 148 full text reports were included with 42 reports describing interventions to address UB in acute healthcare settings. Interventions drew on 13 types of behaviour change strategies and were categorised into five types of intervention (1) single session (i.e. one off); (2) multiple session; (3) single or multiple sessions combined with other actions (e.g. training sessions plus a code of conduct); (4) professional accountability and reporting programmes and; (5) structured culture change interventions. We formulated 55 context-mechanism-outcome configurations to explain how, why, and when these interventions work. We identified twelve key dynamics to consider in intervention design, including importance of addressing systemic contributors, rebuilding trust in managers, and promoting a psychologically safe culture; fifteen implementation principles were identified to address these dynamics.ConclusionsInterventions to address UB are still at an early stage of development, and their effectiveness to reduce UB and improve patient safety is unclear. Future interventions should incorporate knowledge from behavioural and implementation science to affect behaviour change; draw on multiple concurrent strategies to address systemic contributors to UB; and consider the undue burden of UB on minoritised groups.Study registrationThis 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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页数:27
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