Doctors come off worst in hospital ‘bad behaviour’ study

By Geir O'Rourke

27 Nov 2023

An Australian hospital network’s coworker feedback program has shed light on how members of the various health professions feel about their colleagues, and the results make unhappy reading for doctors.

St Vincent’s Health introduced the secure online submission system as part of its ‘Ethos’ initiative, intended to improve the workplace culture at its eight hospitals in Victoria, New South Wales and Queensland.

Staff were asked to report negative or unprofessional behaviour by coworkers, termed ‘Feedback for Reflection’, as well as any positive examples (Feedback for Recognition), with the health service receiving 2504 reports in all between 2017 and 2020.

There was a relatively even split, with 48% of submissions coming in for ‘recognition’ compared to 52% giving a thumbs down to a colleague for their behaviour.

But patterns emerged showing wide variance between each professional group, both in terms of how frequently they took the opportunity to praise or complain about a co-worker and how their behaviour was viewed by others.

Interestingly, submission rates were highest among nurses, who authored 66% of the positive reports and 61% of the negative reports over the three years.

Even taking into account workforce numbers, this equated to approximately 20% of nurses making a submission in that time, compared with only 7% of doctors and 14% of allied health workers.

Nurses were also the most frequent subject of ‘recognition’ submissions, while management and administrative staff were the least.

On the other hand, medical staff were by far the most frequent subjects of negative feedback, with an equivalent of 13% of the group’s doctors receiving a ‘reflection’ submission, compared with 7% of nurses and 6% of allied health staff.

Unprofessional behaviour

Writing in BMJ Open Quality (link here), the researchers stressed this did not necessarily mean 13% of doctors had been the subject of negative feedback, given the likelihood some would have received multiple complaints.

Nevertheless, the numbers were consistent with previous studies which had also found higher rates of unprofessional behaviour among medical staff, they wrote.

Among the reflection submissions, 54% related to ‘being spoken to rudely’, while around a quarter described humiliating or ridiculing behaviour, ‘opinions being ignored’, or shouting respectively.

Other frequent topics included unreasonable workloads (11%), physically intimidating behaviour (10%) and ‘excessive monitoring of work’ (6%).

On the more serious end of the scale, there were nine reports of physical assault, eight of inappropriate or unwanted touching, five of threats of violence and one of sexual assault.

These serious unprofessional behaviours were managed via formal, traditional disciplinary measures.

However, the rest were “triaged and non-punitive feedback delivered by trained peer-messengers to provide an opportunity for staff to reflect on their behaviour,” the authors said.

In addition, staff who were recognised for positive behaviour received direct manager feedback, with positive reports also incorporated into ‘rewards and recognition’ programs, where possible.

This created meaningful recognition, which had been shown to reduce burnout and was broadly supported by staff, the authors added.

“For example, our survey of staff 2.5–3 years after Ethos implementation at five hospitals demonstrated significant reductions in staff reports of unprofessional behaviours, along with improved attitudes towards speaking up,” they wrote.

They concluded: “These findings support the adoption of whole-of-hospital strategies for culture change, rather than focusing on single professional groups.”

“The findings demonstrate that staff will equally embrace opportunities to acknowledge positive behaviours by coworkers as well as report behaviours perceived as unprofessional and which compromise patient safety.”

“The unprofessional behaviours reported in the online messaging system mirrored those found to be reported in large-scale staff surveys, suggesting that such surveys provide a valid approach to assessing the prevalence of these behaviours and changes following intervention implementation.”

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