“Speaking up”: can it stop unprofessional behaviour in hospitals?

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Australian hospital staff with self-reported “speaking-up” skills experienced less incivility and bullying from their colleagues, leading researchers to suggest that training in speaking up would help eliminate unprofessional behaviour.

Published by the MJA, the authors surveyed staff in seven metropolitan tertiary hospitals operated by one health care provider in three states between December 2017 and November 2018 about their experience of unprofessional behaviours, their perceived impact on personal wellbeing, teamwork and care quality, as well as about their speaking-up skills.

Over 5,000 staff members completed the survey, a response rate of 34%. 4,846 respondents (93.6%) reported experiencing at least one unprofessional behaviour during the preceding year, including 2,009 (38.8%) who reported weekly or more frequent incivility or bullying. 753 people (14.5%) reported extreme unprofessional behaviour.

Nurses and non-clinical staff members aged 25–34 years reported incivility/bullying and extreme behaviour more often than other staff and age groups respectively.

Staff with self-reported speaking-up skills experienced less incivility/bullying and extreme behaviour, and also less frequently an impact on their personal wellbeing.

“An important new finding was the strong association between self-assessed speaking-up skills and experiencing unprofessional behaviour,” wrote the authors, led by Professor Johanna Westbrook, Director of the Centre for Health Systems and Safety Research at the Australian Institute of Health Innovation.

“Respondents who reported having such skills were 47% less likely to report frequent experience of incivility or bullying and 20% less likely to report extreme unprofessional behaviour from co-workers than colleagues without these skills. Reporting speaking-up skills was also strongly associated with lower rates of reporting negative impacts on personal wellbeing, teamwork, and quality indicators.

“Health systems in several countries have invested in speaking-up programs, reflecting the expectation that they will reduce the frequency of unprofessional behaviour. That having speaking-up skills reduces the frequency and impact of unprofessional behaviour, as suggested by our results, is therefore plausible,” Westbrook and colleagues wrote.

“The effective elements in these programs need to be identified, as well as factors that support their sustainability and scalability, including the organisational context in which staff are asked to speak up.

“We also found that being comfortable about reporting unprofessional behaviour was significantly associated with staff perceptions of the organisational culture, the effectiveness of their hospital in managing complaints about unprofessional behaviour, and the likely consequences of reporting; staff who believed they would be taken seriously were three times more likely to report bad behaviour.

“Training hospital leaders in how to engage with colleagues to counter disruptive and unprofessional behaviour is critical, including being receptive when staff speak up, and having both the skills and processes for an effective response.”