Hospitals are adopting a fresh non-punitive approach to stamp out unprofessional behaviour such as bullying that has become “endemic” among staff.

Professional accountability programs are increasingly being used to tackle behaviour such as belittling, harassment and poor communication, according to health services researchers writing in the MJA.

In a Perspectives article they say interventions are warranted  because evidence suggests that “even low level unprofessionalism is a significant risk to patient safety”.

They point to study that found intensive care unit teams performed significantly worse when subject to rudeness compared to teams treated respectfully.

But while workplace interventions have been recommended to change the culture of bullying and harassment, they also note there is as yet little evidence to support them.

They highlight the Ethos program which St Vincent’s Health Australia is in the process of rolling out across six public hospitals, nine private hospitals and 16 aged care facilities.

The program enables staff to report negative behaviour by a colleague anonymously using an online portal. A “peer messenger” will then communicate the substance of the report to the subject of the complaint, encouraging them to reflect upon their actions.

The program, which draws on models used at Vanderbilt University Medical Center in the US, aims to “call out unprofessional behaviour by removing the barrier of having to report this type of behaviour to superiors who hold the power over career progression”, according to the authors of the MJA article, who include Ethos co-founder Catherine Jones.

“The purpose is not to investigate incidents but to have trained peer messengers convey to the subject of the report the perceived effects of their behaviour on others,” they say. “The intention is to encourage self reflection and behaviour change.”

Mark Zacka, Director Clinical Governance St Vincent’s Health Network Sydney, tells the limbic that most staff have embraced the Ethos program.

To date, between 40 and 50 staff had become peer messengers and 360 reports have been filed (230 negative/130 positive) since roll out at St Vincent’s Public Hospital Melbourne (July 2017) and St Vincent’s Private Hospital Melbourne (June 2018).

And while only 30% of people declined to put their name to a report, anonymity is an important feature, Mr Zacka says .

“We felt if there wasn’t the capacity to be anonymous then some people, particularly the most vulnerable, may not choose to use it [for fear it could lead to bullying].”

The peer-to-peer support element is also crucial, he says.

“A senior doctor may be more likely to listen to and respond to a senior doctor because there is a lived experience they have both shared. We think peers are going to be able to find a better way to connect than perhaps someone from a different discipline. It’s trying to remove that hierarchical component.”

More serious complaints are triaged to a formal disciplinary process, says Mr Zacka.

And while there were initial concerns about the potential for the system to be abused, this has not emerged as a significant problem, he adds.

“What we have found to date is they are only a handful of [vexatious] complaints, and they are pretty easily identified and weeded out.”

The program will be subjected to external evaluation after four years to assess whether it has reduced rates of unprofessional behaviour and improved patient outcomes.

“We now know that if staff feel happy, safe and valued their performance will be better and that will translate into better patient care, and that’s what we’re here for,” Mr Mackie says.