ArticleBMC health services research2024
Evaluation of a culture change program to reduce unprofessional behaviours by hospital co-workers in Australian hospitals.
Article in BMC health services research, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.
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Who cites it
5 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Systematically analyzing behavior change techniques used in 44 interventions to reduce unprofessional behavior between healthcare staff.Translational behavioral medicine · 2025Pooled it
- Workforce and system implications of unprofessional behavior: a nationwide mixed-methods study in Thai emergency medicine.BMC health services research · 2026Article
- A 360-Degree View of Unprofessional Behaviours Between Nurses and Between Nurses and Medical Colleagues: A Secondary Analysis of a Mixed-Method Evaluation.Journal of nursing management · 2026Article
- Allied health professionals' experiences of co-worker unprofessional behaviour and their reported speaking-up skills: A secondary analysis of a cross-sectional survey.Future healthcare journal · 2025Article
- Co-worker unprofessional behaviour and patient safety risks: an analysis of co-worker reports across eight Australian hospitals.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2024Article
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Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundUnprofessional behaviours between healthcare workers are highly prevalent. Evaluations of large-scale culture change programs are rare resulting in limited evidence of intervention effectiveness. We conducted a multi-method evaluation of a professional accountability and culture change program "Ethos" implemented across eight Australian hospitals. The Ethos program incorporates training for staff in speaking-up; an online system for reporting co-worker behaviours; and a tiered accountability pathway, including peer-messengers who deliver feedback to staff for 'reflection' or 'recognition'. Here we report the final evaluation component which aimed to measure changes in the prevalence of unprofessional behaviours before and after Ethos.
methodsA survey of staff (clinical and non-clinical) experiences of 26 unprofessional behaviours across five hospitals at baseline before (2018) and 2.5-3 years after (2021/2022) Ethos implementation. Five of the 26 behaviours were classified as 'extreme' (e.g., assault) and 21 as incivility/bullying (e.g., being spoken to rudely). Our analysis assessed changes in four dimensions: work-related bullying; person-related bullying; physical bullying and sexual harassment. Change in experience of incivility/bullying was compared using multivariable ordinal logistic regression. Change in extreme behaviours was assessed using multivariable binary logistic regression. All models were adjusted for respondent characteristics.
resultsIn total, 3975 surveys were completed. Staff reporting frequent incivility/bullying significantly declined from 41.7% (n = 1064; 95% CI 39.7,43.9) at baseline to 35.5% (n = 505; 95% CI 32.8,38.3; χ
conclusionThe Ethos program was associated with significant reductions in the prevalence of reported unprofessional behaviours and improved capacity of hospital staff to speak-up. These results add to evidence that staff will actively engage with a system that supports informal feedback to co-workers about their behaviours and is facilitated by trained peer messengers.
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