PDF(Pubmed)
Abstract：
BACKGROUND: Unprofessional 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.
METHODS: A 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.
RESULTS: In 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; χ2(1) = 14.3; P < 0.001) post-Ethos. The odds of experiencing incivility/bullying declined by 24% (adjusted odds ratio [aOR] 0.76; 95% CI 0.66,0.87; P < 0.001) and odds of experiencing extreme behaviours by 32% (aOR 0.68; 95% CI 0.54,0.85; P < 0.001) following Ethos. All four dimensions showed a reduction of 32-41% in prevalence post-Ethos. Non-clinical staff reported the greatest decrease in their experience of unprofessional behaviour (aOR 0.41; 95% CI 0.29, 0.61). Staff attitudes and reported skills to speak-up were significantly more positive at follow-up. Awareness of the program was high (82.1%; 95% CI 80.0, 84.0%); 33% of respondents had sent or received an Ethos message.
CONCLUSIONS: The 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.
METHODS: A 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.
RESULTS: In 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; χ2(1) = 14.3; P < 0.001) post-Ethos. The odds of experiencing incivility/bullying declined by 24% (adjusted odds ratio [aOR] 0.76; 95% CI 0.66,0.87; P < 0.001) and odds of experiencing extreme behaviours by 32% (aOR 0.68; 95% CI 0.54,0.85; P < 0.001) following Ethos. All four dimensions showed a reduction of 32-41% in prevalence post-Ethos. Non-clinical staff reported the greatest decrease in their experience of unprofessional behaviour (aOR 0.41; 95% CI 0.29, 0.61). Staff attitudes and reported skills to speak-up were significantly more positive at follow-up. Awareness of the program was high (82.1%; 95% CI 80.0, 84.0%); 33% of respondents had sent or received an Ethos message.
CONCLUSIONS: The 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.
摘要：
背景：医护人员之间的非专业行为非常普遍。对大规模文化改变计划的评估很少，导致干预效果的证据有限。我们对八家澳大利亚医院实施的专业问责制和文化变革计划“Ethos”进行了多方法评估。Ethos计划包括对员工进行演讲培训；报告同事行为的在线系统；以及分层的问责途径，包括向员工提供“反思”或“认可”反馈的同行信使。在这里，我们报告了最终评估组件，该组件旨在衡量Ethos前后非专业行为患病率的变化。
方法：在实施Ethos之前（2018年）和之后（2021/2022年）2.5-3年，对五家医院的26种非专业行为的员工（临床和非临床）经历进行了调查。26种行为中有5种被归类为“极端”(例如，攻击)和21为无礼/欺凌(例如，粗鲁地说话)。我们的分析评估了四个方面的变化：与工作有关的欺凌；与人有关的欺凌；身体欺凌和性骚扰。使用多变量序数逻辑回归比较了不礼貌/欺凌经验的变化。使用多变量二元逻辑回归评估极端行为的变化。所有模型均针对应答者特征进行了调整。
结果：总计，完成3975项调查。报告频繁不礼貌/欺凌行为的员工从基线时的41.7%(n=1064;95%CI39.7,43.9)显著下降至精神精神疗法后的35.5%(n=505;95%CI32.8,38.3;χ2(1)=14.3;P<0.001)。在Ethos之后，经历无礼/欺凌的几率下降了24%(调整后的几率[aOR]0.76;95%CI0.66,0.87;P<0.001)，经历极端行为的几率下降了32%(aOR0.68;95%CI0.54,0.85;P<0.001)。所有四个方面都显示出种族精神后患病率降低了32-41％。非临床工作人员报告其非专业行为的经验减少最大（aOR0.41；95％CI0.29，0.61）。在后续行动中，工作人员的态度和报告的发言技能明显更加积极。该计划的认知度很高（82.1％；95％CI80.0，84.0％）；33％的受访者发送或收到了Ethos消息。
结论：Ethos计划与报告的非专业行为的患病率显着降低有关，并提高了医院工作人员的发言能力。这些结果增加了证据，表明员工将积极参与一个系统，该系统支持向同事提供有关其行为的非正式反馈，并由训练有素的同伴信使提供便利。
方法：在实施Ethos之前（2018年）和之后（2021/2022年）2.5-3年，对五家医院的26种非专业行为的员工（临床和非临床）经历进行了调查。26种行为中有5种被归类为“极端”(例如，攻击)和21为无礼/欺凌(例如，粗鲁地说话)。我们的分析评估了四个方面的变化：与工作有关的欺凌；与人有关的欺凌；身体欺凌和性骚扰。使用多变量序数逻辑回归比较了不礼貌/欺凌经验的变化。使用多变量二元逻辑回归评估极端行为的变化。所有模型均针对应答者特征进行了调整。
结果：总计，完成3975项调查。报告频繁不礼貌/欺凌行为的员工从基线时的41.7%(n=1064;95%CI39.7,43.9)显著下降至精神精神疗法后的35.5%(n=505;95%CI32.8,38.3;χ2(1)=14.3;P<0.001)。在Ethos之后，经历无礼/欺凌的几率下降了24%(调整后的几率[aOR]0.76;95%CI0.66,0.87;P<0.001)，经历极端行为的几率下降了32%(aOR0.68;95%CI0.54,0.85;P<0.001)。所有四个方面都显示出种族精神后患病率降低了32-41％。非临床工作人员报告其非专业行为的经验减少最大（aOR0.41；95％CI0.29，0.61）。在后续行动中，工作人员的态度和报告的发言技能明显更加积极。该计划的认知度很高（82.1％；95％CI80.0，84.0％）；33％的受访者发送或收到了Ethos消息。
结论：Ethos计划与报告的非专业行为的患病率显着降低有关，并提高了医院工作人员的发言能力。这些结果增加了证据，表明员工将积极参与一个系统，该系统支持向同事提供有关其行为的非正式反馈，并由训练有素的同伴信使提供便利。
