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Baniulyte G, Jajeh N, Kandhari S, Lin YM, Magill S, Malcolm L, McGuckin B, Morphet E, Goodall CA. Inappropriate behaviours in a dental training environment: pilot of a UK-wide questionnaire. Br Dent J 2023; 235:859-863. [PMID: 38066139 DOI: 10.1038/s41415-023-6553-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/02/2023] [Accepted: 06/21/2023] [Indexed: 12/18/2023]
Abstract
Incivility and inappropriate behaviour in the workplace are topics of growing interest due to their impact on patient care and safety. Several surveys and campaigns have emerged highlighting the existence of a problem. However, the true scale is difficult to ascertain. The aim of this study is to determine the existence of inappropriate behaviours within the UK dental training environment.An anonymous pilot questionnaire was distributed across multiple platforms reaching out to dental professionals within training environments, inviting responses between July 2022 and October 2022. A total of 215 responses were received. The vast majority (73.2%) felt that inappropriate behaviour is a problem within UK dental training. Senior colleagues were identified as perpetrators in 88% of responses. Most respondents (66%) reported feeling uncomfortable raising the issue, and when raised, 30% felt unsupported. Only 9% felt confident that action was taken after the issue was reported. Belittling was experienced and witnessed most commonly.The feedback received reveals the existence of inappropriate behaviours within dental training environments. Qualitative feedback indicates that if left unaddressed, the impact of such behaviour may persist long-term. Further research is required to address this issue, improve dental training conditions and job satisfaction.
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Affiliation(s)
- Gabriele Baniulyte
- Royal College of Physicians and Surgeons Glasgow, Dental Trainees´ Committee, Glasgow, Scotland, United Kingdom.
| | - Neda Jajeh
- Royal College of Physicians and Surgeons Glasgow, Dental Trainees´ Committee, Glasgow, Scotland, United Kingdom
| | - Sunmeet Kandhari
- Royal College of Physicians and Surgeons Glasgow, Dental Trainees´ Committee, Glasgow, Scotland, United Kingdom
| | - Yen Ming Lin
- Royal College of Physicians and Surgeons Glasgow, Dental Trainees´ Committee, Glasgow, Scotland, United Kingdom
| | - Stephen Magill
- Royal College of Physicians and Surgeons Glasgow, Dental Trainees´ Committee, Glasgow, Scotland, United Kingdom
| | - Lucy Malcolm
- Royal College of Physicians and Surgeons Glasgow, Dental Trainees´ Committee, Glasgow, Scotland, United Kingdom
| | - Bronagh McGuckin
- Royal College of Physicians and Surgeons Glasgow, Dental Trainees´ Committee, Glasgow, Scotland, United Kingdom
| | - Elizabeth Morphet
- Royal College of Physicians and Surgeons Glasgow, Dental Trainees´ Committee, Glasgow, Scotland, United Kingdom
| | - Christine A Goodall
- Royal College of Physicians and Surgeons Glasgow, Dental Trainees´ Committee, Glasgow, Scotland, United Kingdom
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Aunger JA, Maben J, Abrams R, Wright JM, Mannion R, Pearson M, Jones A, Westbrook JI. Drivers of unprofessional behaviour between staff in acute care hospitals: a realist review. BMC Health Serv Res 2023; 23:1326. [PMID: 38037093 PMCID: PMC10687856 DOI: 10.1186/s12913-023-10291-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/07/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Unprofessional behaviours (UB) between healthcare staff are rife in global healthcare systems, negatively impacting staff wellbeing, patient safety and care quality. Drivers of UBs include organisational, situational, team, and leadership issues which interact in complex ways. An improved understanding of these factors and their interactions would enable future interventions to better target these drivers of UB. METHODS A realist review following RAMESES guidelines was undertaken with stakeholder input. Initial theories were formulated drawing on reports known to the study team and scoping searches. A systematic search of databases including Embase, CINAHL, MEDLINE and HMIC was performed to identify literature for theory refinement. Data were extracted from these reports, synthesised, and initial theories tested, to produce refined programme theories. RESULTS We included 81 reports (papers) from 2,977 deduplicated records of grey and academic reports, and 28 via Google, stakeholders, and team members, yielding a total of 109 reports. Five categories of contributor were formulated: (1) workplace disempowerment; (2) harmful workplace processes and cultures; (3) inhibited social cohesion; (4) reduced ability to speak up; and (5) lack of manager awareness and urgency. These resulted in direct increases to UB, reduced ability of staff to cope, and reduced ability to report, challenge or address UB. Twenty-three theories were developed to explain how these contributors work and interact, and how their outcomes differ across diverse staff groups. Staff most at risk of UB include women, new staff, staff with disabilities, and staff from minoritised groups. UB negatively impacted patient safety by impairing concentration, communication, ability to learn, confidence, and interpersonal trust. CONCLUSION Existing research has focused primarily on individual characteristics, but these are inconsistent, difficult to address, and can be used to deflect organisational responsibility. We present a comprehensive programme theory furthering understanding of contributors to UB, how they work and why, how they interact, whom they affect, and how patient safety is impacted. More research is needed to understand how and why minoritised staff are disproportionately affected by UB. STUDY REGISTRATION This study was registered on the international database of prospectively registered systematic reviews in health and social care (PROSPERO): https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021255490 .
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Affiliation(s)
- Justin Avery Aunger
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
- NIHR Midlands Patient Safety Research Collaboration, University of Birmingham, Birmingham, UK.
| | - Jill Maben
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Ruth Abrams
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Judy M Wright
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Russell Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Aled Jones
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Johanna I Westbrook
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
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Maben J, Aunger JA, Abrams R, Wright JM, Pearson M, Westbrook JI, Jones A, Mannion R. Interventions to address unprofessional behaviours between staff in acute care: what works for whom and why? A realist review. BMC Med 2023; 21:403. [PMID: 37904186 PMCID: PMC10617100 DOI: 10.1186/s12916-023-03102-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/04/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Unprofessional behaviour (UB) between staff encompasses various behaviours, including incivility, microaggressions, harassment, and bullying. UB is pervasive in acute healthcare settings and disproportionately impacts minoritised staff. UB has detrimental effects on staff wellbeing, patient safety and organisational resources. While interventions have been implemented to mitigate UB, there is limited understanding of how and why they may work and for whom. METHODS This study utilised a realist review methodology with stakeholder input to improve understanding of these complex context-dependent interventions. Initial programme theories were formulated drawing upon scoping searches and reports known to the study team. Purposive systematic searches were conducted to gather grey and published global literature from databases. Documents were selected if relevant to UB in acute care settings while considering rigour and relevance. Data were extracted from these reports, synthesised, and initial theories tested, to produce refined programme theories. RESULTS Of 2977 deduplicated records, 148 full text reports were included with 42 reports describing interventions to address UB in acute healthcare settings. Interventions drew on 13 types of behaviour change strategies and were categorised into five types of intervention (1) single session (i.e. one off); (2) multiple session; (3) single or multiple sessions combined with other actions (e.g. training sessions plus a code of conduct); (4) professional accountability and reporting programmes and; (5) structured culture change interventions. We formulated 55 context-mechanism-outcome configurations to explain how, why, and when these interventions work. We identified twelve key dynamics to consider in intervention design, including importance of addressing systemic contributors, rebuilding trust in managers, and promoting a psychologically safe culture; fifteen implementation principles were identified to address these dynamics. CONCLUSIONS Interventions to address UB are still at an early stage of development, and their effectiveness to reduce UB and improve patient safety is unclear. Future interventions should incorporate knowledge from behavioural and implementation science to affect behaviour change; draw on multiple concurrent strategies to address systemic contributors to UB; and consider the undue burden of UB on minoritised groups. STUDY REGISTRATION This study was registered on the international database of prospectively registered systematic reviews in health and social care (PROSPERO): https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021255490 .
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Affiliation(s)
- Jill Maben
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Justin Avery Aunger
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
- NIHR Midlands Patient Safety Research Collaboration, University of Birmingham, Birmingham, UK.
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | - Ruth Abrams
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Judy M Wright
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Johanna I Westbrook
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Aled Jones
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Russell Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, UK
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Kolbe M, Goldhahn J, Useini M, Grande B. "Asking for help is a strength"-how to promote undergraduate medical students' teamwork through simulation training and interprofessional faculty. Front Psychol 2023; 14:1214091. [PMID: 37701867 PMCID: PMC10494543 DOI: 10.3389/fpsyg.2023.1214091] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/01/2023] [Indexed: 09/14/2023] Open
Abstract
The ability to team up and safely work in any kind of healthcare team is a critical asset and should be taught early on in medical education. Medical students should be given the chance to "walk the talk" of teamwork by training and reflecting in teams. Our goal was to design, implement and evaluate the feasibility of a simulation-based teamwork training (TeamSIM) for undergraduate medical students that puts generic teamwork skills centerstage. We designed TeamSIM to include 12 learning objectives. For this pre-post, mixed-methods feasibility study, third-year medical students, organized in teams of 11-12 students, participated and observed each other in eight simulations of different clinical situation with varying degrees of complexity (e.g., deteriorating patient in ward; trauma; resuscitation). Guided by an interprofessional clinical faculty with simulation-based instructor training, student teams reflected on their shared experience in structured team debriefings. Using published instruments, we measured (a) students' reactions to TeamSIM and their perceptions of psychological safety via self-report, (b) their ongoing reflections via experience sampling, and (c) their teamwork skills via behavior observation. Ninety four students participated. They reported positive reactions to TeamSIM (M = 5.23, SD = 0.5). Their mean initial reported level of psychological safety was M = 3.8 (SD = 0.4) which rose to M = 4.3 (SD = 0.5) toward the end of the course [T(21) = -2.8, 95% CI -0.78 to-0.12, p = 0.011 (two-tailed)]. We obtained n = 314 headline reflections from the students and n = 95 from the faculty. For the students, the most frequent theme assigned to their headlines involved the concepts taught in the course such as "10 s for 10 min." For the faculty, the most frequent theme assigned to their headlines were reflections on how their simulation session worked for the students. The faculty rated students' teamwork skills higher after the last compared to the first debriefing. Undergraduate medical students can learn crucial teamwork skills in simulations supported by an experienced faculty and with a high degree of psychological safety. Both students and faculty appreciate the learning possibilities of simulation. At the same time, this learning can be challenging, intense and overwhelming. It takes a team to teach teamwork.
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Affiliation(s)
- Michaela Kolbe
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland
- Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Jörg Goldhahn
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Mirdita Useini
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Bastian Grande
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
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Vauk S, Seelandt JC, Huber K, Grande B, Kolbe M. Exposure to incivility does not hinder speaking up: a randomised controlled high-fidelity simulation-based study. Br J Anaesth 2022; 129:776-787. [PMID: 36075775 DOI: 10.1016/j.bja.2022.07.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 06/27/2022] [Accepted: 07/26/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Speaking up with concerns is critical for patient safety. We studied whether witnessing a civil (i.e. polite, respectful) response to speaking up would increase the occurrence of further speaking up by hospital staff members as compared with witnessing a pseudo-civil (i.e. vague and slightly dismissive) or rude response. METHODS In this RCT in a single, large academic teaching hospital, a single simulated basic life support scenario was designed to elicit standardised opportunities to speak up. Participants in teams of two or three were randomly assigned to one of three experimental conditions in which the degree of civility in reacting to speaking up was manipulated by an embedded simulated person. Speaking up behaviour was assessed by behaviour coding of the video recordings of the team interactions by applying 10 codes using The Observer XT 14.1. Data were analysed using multilevel modelling. RESULTS The sample included 125 interprofessional hospital staff members (82 [66%] women, 43 [34%] men). Participants were more likely to speak up when they felt psychologically safe (γ=0.47; standard error [se]=0.19; 95% confidence interval [CI], 0.09-0.85; P=0.017). Participants were more likely to speak up in the rude condition than in the other conditions (γ=0.28; se=0.12; 95% CI, 0.05-0.52; P=0.019). Across conditions, participants spoke up most frequently by structuring inquiry (n=289, 31.52%), proactive (n=240, 26.17%), and reactive (n=148, 16.14%) instruction statements, and gestures (n=139, 15.16%). CONCLUSION Our study challenges current assumptions about the interplay of civility and speaking up behaviour in healthcare.
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Affiliation(s)
- Stefanie Vauk
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland
| | - Julia C Seelandt
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland
| | - Katja Huber
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland
| | - Bastian Grande
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland; Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Michaela Kolbe
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland; ETH Zurich, Zurich, Switzerland.
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