Creating a culture of safety and respect through professional accountability: case study of the Ethos program across eight Australian hospitals
Kate Churruca A * , Antoinette Pavithra A , Ryan McMullan A , Rachel Urwin A , Stephen Tippett B , Neil Cunningham C , Erwin Loh D and Johanna Westbrook A
+ Author Affiliations
- Author Affiliations
A Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia.
B People Services, St Vincent’s Hospital Melbourne, Fitzroy, Vic., Australia.
C Emergency Department, St Vincent’s Hospital Melbourne, Fitzroy, Vic., Australia.
D St Vincent's Health Australia, East Melbourne, Vic., Australia.
* Correspondence to: Kate.churruca@mq.edu.au
Australian Health Review 46(3) 319-324 https://doi.org/10.1071/AH21308
Submitted: 17 November 2021 Accepted: 10 April 2022 Published: 12 May 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.
Abstract
Behaviour that is disrespectful towards others occurs frequently in hospitals, negatively impacts staff, and may undermine patient care. Professional accountability programs may address unprofessional behaviour by staff. This article examines a whole-of-hospital program, Ethos, developed by St Vincent’s Health Australia to address unprofessional behaviour, encourage speaking up, and improve organisational culture. Ethos consists of a bundle of tools, training, and resources, including an online system where staff can make submissions regarding their co-workers’ exemplary or unprofessional behaviour. Informal feedback is provided to the subject of the submission to recognise or encourage reflection on their behaviour. Following implementation in eight St Vincent’s Health Australia hospitals, the Ethos Messaging System has had 2497 submissions, 54% about positive behaviours. Peer messengers who deliver ‘Feedback for Reflection’ have faced practical challenges in providing feedback. Guidelines for the team who ‘triage’ Ethos messages have been revised to ensure only feedback that will promote reflection is passed on. Early evidence suggests Ethos has positively impacted staff, although evaluation is ongoing. The COVID-19 pandemic has required some adaptations to the program.
Keywords: culture change, feedback, hospital, incivility, organisational culture, professional accountability, professionalism, unprofessional behaviour.
References
[1] Braithwaite J, Herkes J, Ludlow K, Testa L, Lamprell G. Association between organisational and workplace cultures, and patient outcomes: systematic review. BMJ Open 2017; 7 e017708| Association between organisational and workplace cultures, and patient outcomes: systematic review.Crossref | GoogleScholarGoogle Scholar | 29122796PubMed |
[2] Johnson C. Bad blood: doctor-nurse behavior problems impact patient care. Physician Executive 2009; 35 6–11.
| 19999685PubMed |
[3] Saxton R, Hines T, Enriquez M. The negative impact of nurse-physician disruptive behavior on patient safety: a review of the literature. J Patient Saf 2009; 5 180–3.
| The negative impact of nurse-physician disruptive behavior on patient safety: a review of the literature.Crossref | GoogleScholarGoogle Scholar | 19927052PubMed |
[4] Riskin A, Erez A, Foulk TA, Riskin-Geuz KS, Ziv A, Sela R, et al. Rudeness and medical team performance. Pediatrics 2017; 139 e20162305
| Rudeness and medical team performance.Crossref | GoogleScholarGoogle Scholar | 28073958PubMed |
[5] Villafranca A, Hamlin C, Enns S, Jacobsohn E. Disruptive behaviour in the perioperative setting: a contemporary review. Can J Anaesth 2017; 64 128–40.
| Disruptive behaviour in the perioperative setting: a contemporary review.Crossref | GoogleScholarGoogle Scholar | 27900669PubMed |
[6] Schilpzand P, De Pater IE, Erez A. Workplace incivility: A review of the literature and agenda for future research. J Organ Behav 2016; 37 S57–S88.
| Workplace incivility: A review of the literature and agenda for future research.Crossref | GoogleScholarGoogle Scholar |
[7] Agency for Healthcare Research and Quality. Disruptive and unprofessional behavior. Rockville, MD: Patient Safety Network; 2019. Available at https://psnet.ahrq.gov/primer/disruptive-and-unprofessional-behavior
[8] Swiggart WH, Dewey CM, Hickson GB, Finlayson AJR, Spickard Jr WA. A plan for identification, treatment, and remediation of disruptive behaviors in physicians. Front Health Serv Manage 2009; 25 3–11.
| A plan for identification, treatment, and remediation of disruptive behaviors in physicians.Crossref | GoogleScholarGoogle Scholar | 19603686PubMed |
[9] Westbrook J, Sunderland N, Atkinson V, Jones C, Braithwaite J. Endemic unprofessional behaviour in health care: the mandate for a change in approach. Med J Aust 2018; 209 380–1.
| Endemic unprofessional behaviour in health care: the mandate for a change in approach.Crossref | GoogleScholarGoogle Scholar | 30376656PubMed |
[10] Westbrook J, Sunderland N, Li L, Koyama A, McMullan R, Urwin R, et al. The prevalence and impact of unprofessional behaviour among hospital workers: a survey in seven Australian hospitals. Med J Aust 2021; 214 31–7.
| The prevalence and impact of unprofessional behaviour among hospital workers: a survey in seven Australian hospitals.Crossref | GoogleScholarGoogle Scholar | 33174226PubMed |
[11] Webb LE, Dmochowski RR, Moore IN, Pichert JW, Catron TF, Troyer M, et al. Using coworker observations to promote accountability for disrespectful and unsafe behaviors by physicians and advanced practice professionals. Jt Comm J Qual Patient Saf 2016; 42 149–64. , AP1–3
| Using coworker observations to promote accountability for disrespectful and unsafe behaviors by physicians and advanced practice professionals.Crossref | GoogleScholarGoogle Scholar | 27025575PubMed |
[12] Hickson GB, Federspiel CF, Pichert JW, Miller CS, Gauld-Jaeger J, Bost P. Patient complaints and malpractice risk. JAMA 2002; 287 2951–7.
| Patient complaints and malpractice risk.Crossref | GoogleScholarGoogle Scholar | 12052124PubMed |
[13] Cydulka RK, Tamayo-Sarver J, Gage A, Bagnoli D. Association of patient satisfaction with complaints and risk management among emergency physicians. J Emerg Med 2011; 41 405–11.
| Association of patient satisfaction with complaints and risk management among emergency physicians.Crossref | GoogleScholarGoogle Scholar | 21215554PubMed |
[14] Bismark MM, Spittal MJ, Gurrin LC, Ward M, Studdert DM. Identification of doctors at risk of recurrent complaints: a national study of healthcare complaints in Australia. BMJ Qual Saf 2013; 22 532–40.
| Identification of doctors at risk of recurrent complaints: a national study of healthcare complaints in Australia.Crossref | GoogleScholarGoogle Scholar | 23576774PubMed |
[15] DuPree E, Anderson R, McEvoy MD, Brodman M. Professionalism: a necessary ingredient in a culture of safety. Jt Comm J Qual Patient Saf 2011; 37 447–55.
| Professionalism: a necessary ingredient in a culture of safety.Crossref | GoogleScholarGoogle Scholar | 22013818PubMed |
[16] Victorian Auditor-General’s Report. Bullying and harrassment in the health sector. Melbourne: Victorian Auditor General’s Office; 2016.
[17] McKenzie L, Shaw L, Jordan JE, Alexander M, O’Brien M, Singer SJ, et al. Factors influencing the implementation of a hospital-wide intervention to promote professionalism and build a safety culture: a qualitative study. Jt Comm J Qual Patient Saf 2019; 45 694–705.
| Factors influencing the implementation of a hospital-wide intervention to promote professionalism and build a safety culture: a qualitative study.Crossref | GoogleScholarGoogle Scholar | 31471212PubMed |
[18] Hickson GB, Pichert JW, Webb LE, Gabbe SG. A Complementary approach to promoting professionalism: identifying, measuring, and addressing unprofessional behaviors. Acad Med 2007; 82 1040–8.
| A Complementary approach to promoting professionalism: identifying, measuring, and addressing unprofessional behaviors.Crossref | GoogleScholarGoogle Scholar | 17971689PubMed |
[19] Pichert JW, Moore IN, Karrass J, Jay JS, Westlake MW, Catron TF, et al. An intervention model that promotes accountability: peer messengers and patient/family complaints. Jt Comm J Qual Patient Saf 2013; 39 435–46. , AP1–8
| An intervention model that promotes accountability: peer messengers and patient/family complaints.Crossref | GoogleScholarGoogle Scholar | 24195197PubMed |
[20] Pichert JW, Johns JA, Hickson GB. Professionalism in support of pediatric cardio-thoracic surgery: a case of a bright young surgeon. Prog Pediatr Cardiol 2011; 32 89–96.
| Professionalism in support of pediatric cardio-thoracic surgery: a case of a bright young surgeon.Crossref | GoogleScholarGoogle Scholar |
[21] Leape LL, Shore MF, Dienstag JL, Mayer RJ, Edgman-Levitan S, Meyer GS, et al. Perspective: a culture of respect, Part 1: the nature and causes of disrespectful behavior by physicians. Acad Med 2012; 87 845–52.
| Perspective: a culture of respect, Part 1: the nature and causes of disrespectful behavior by physicians.Crossref | GoogleScholarGoogle Scholar | 22622217PubMed |
[22] Amalberti R, Vincent C, Auroy Y, de Saint Maurice G. Violations and migrations in health care: a framework for understanding and management. Qual Saf Health Care 2006; 15 i66
| 17142612PubMed |
[23] St Vincent’s Health Australia. Mission, Vision & Values. 2021. Available at https://www.svha.org.au/mission/mission-vision-and-values
[24] St Vincent’s Health Australia. Our Care. 2021. Available at https://www.svha.org.au/mission/our-care
[25] Royal Australasian College of Surgeons. Expert Advisory Group on discrimination, bullying and sexual harrassment. East Melbourne: RACS; 2015.
[26] NSW Government, Fire and Rescue NSW. Preventing and Responding to Bullying and Harassment. Policy number: CG 09-003. Sydney: Fire and Rescue NSW; 2015.
[27] NHS National Patient Safety Agency. The Incident Decision Tree: Information and advice on use. 2003. Available at http://www.suspension-nhs.org/Resources/Safety%20-%20IDT%20(info%20and%20advice%20on%20use).pdf
[28] St Vincent’s Health Australia. Ethos Procedure 2020: Building a culture of safety and respect. Sydney: SVHA; 2020.
[29] Fast I, Villafranca A, Henrichs B, Magid K, Christodoulou C, Jacobsohn E. Disruptive behaviour in the operating room is under-reported: an international survey. Canadian Journal of Anesthesia/Journal canadien d'anesthésie 2020; 67 177–185.
| Disruptive behaviour in the operating room is under-reported: an international survey.Crossref | GoogleScholarGoogle Scholar | 31950465PubMed |
[30] Nacioglu A. As a critical behavior to improve quality and patient safety in health care: speaking up! Safety Health 2016; 2 1–25.
| As a critical behavior to improve quality and patient safety in health care: speaking up!Crossref | GoogleScholarGoogle Scholar |
