Retrospective analysis of factors influencing the implementation of a program to addressunprofessional behaviour and improve culture in Australian hospitals

Journal article


Churruca, Kate, Westbrook, Johanna, Bagot, Kathleen L., McMullan, Ryan, Urwin, Rachel, Cunningham, Neil, Mitchell, Rebecca, Hibbert, Peter, Sunderland, Neroli, Loh, Erwin and Taylor, Natalie. (2023). Retrospective analysis of factors influencing the implementation of a program to addressunprofessional behaviour and improve culture in Australian hospitals. BMC Health Services Research. 23, pp. 1-16. https://doi.org/10.1186/s12913-023-09614-1
AuthorsChurruca, Kate, Westbrook, Johanna, Bagot, Kathleen L., McMullan, Ryan, Urwin, Rachel, Cunningham, Neil, Mitchell, Rebecca, Hibbert, Peter, Sunderland, Neroli, Loh, Erwin and Taylor, Natalie
Abstract

Background: Unprofessional behaviour among hospital staff is common. Such behaviour negatively impacts on staff wellbeing and patient outcomes. Professional accountability programs collect information about unprofessional staff behaviour from colleagues or patients, providing this as informal feedback to raise awareness, promote reflection, and change behaviour. Despite increased adoption, studies have not assessed the implementation of these programs utilising implementation theory. This study aims to (1) identify factors influencing the implementation of a whole-of-hospital professional accountability and culture change program, Ethos, implemented in eight hospitals within a large healthcare provider group, and (2) examine whether expert recommended implementation strategies were intuitively used during implementation, and the degree to which they were operationalised to address identified barriers.

Method: Data relating to implementation of Ethos from organisational documents, interviews with senior and middle management, and surveys of hospital staff and peer messengers were obtained and coded in NVivo using the Consolidated Framework for Implementation Research (CFIR). Implementation strategies to address identified barriers were generated using Expert Recommendations for Implementing Change (ERIC) strategies and used in a second round of targeted coding, then assessed for degree of alignment to contextual barriers.

Results: Four enablers, seven barriers, and three mixed factors were found, including perceived limitations in the confidential nature of the online messaging tool (‘Design quality and packaging’), which had downstream challenges for the capacity to provide feedback about utilisation of Ethos (‘Goals and Feedback’, ‘Access to Knowledge and Information’). Fourteen recommended implementation strategies were used, however, only four of these were operationalised to completely address contextual barriers.

Conclusion: Aspects of the inner setting (e.g., ‘Leadership Engagement’, ‘Tension for Change’) had the greatest influence on implementation and should be considered prior to the implementation of future professional accountability programs. Theory can improve understanding of factors affecting implementation, and support strategies to address them.

KeywordsUnprofessional behaviour; Professional accountability program; Culture change; Hospital culture; CFIR; Implementation determinants; Evaluation
Year01 Jan 2023
JournalBMC Health Services Research
Journal citation23, pp. 1-16
PublisherBMC (BioMed Central) Springer
ISSN1472-6963
Digital Object Identifier (DOI)https://doi.org/10.1186/s12913-023-09614-1
Web address (URL)https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-023-09614-1
Open accessPublished as ‘gold’ (paid) open access
Research or scholarlyResearch
Page range1-16
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online07 Jun 2023
Publication process dates
Accepted24 May 2023
Deposited19 Aug 2024
Supplemental file
License
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Open
Supplemental file
License
File Access Level
Open
Supplemental file
License
File Access Level
Open
Supplemental file
License
File Access Level
Open
Supplemental file
License
File Access Level
Open
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© The Author(s) 2023.

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver (
http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Place of publicationUnited Kingdom
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