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.
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。