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
Authors | Churruca, 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. |
Keywords | Unprofessional behaviour; Professional accountability program; Culture change; Hospital culture; CFIR; Implementation determinants; Evaluation |
Year | 01 Jan 2023 |
Journal | BMC Health Services Research |
Journal citation | 23, pp. 1-16 |
Publisher | BMC (BioMed Central) Springer |
ISSN | 1472-6963 |
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 access | Published as ‘gold’ (paid) open access |
Research or scholarly | Research |
Page range | 1-16 |
Publisher's version | License File Access Level Open |
Output status | Published |
Publication dates | |
Online | 07 Jun 2023 |
Publication process dates | |
Accepted | 24 May 2023 |
Deposited | 19 Aug 2024 |
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 |
Supplemental file | License File Access Level Open |
Additional information | © 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 ( | |
Place of publication | United Kingdom |
https://acuresearchbank.acu.edu.au/item/90wy6/retrospective-analysis-of-factors-influencing-the-implementation-of-a-program-to-addressunprofessional-behaviour-and-improve-culture-in-australian-hospitals
Download files
Publisher's version
OA_Bagot_2023_Retrospective_analysis_of_factors_influencing_the.pdf | |
License: CC BY 4.0 | |
File access level: Open |
Supplemental file
SM1_Bagot_2023_Retrospective_analysis_of_factors_influencing_the.pdf | |
License: CC BY 4.0 | |
File access level: Open |
SM2_Bagot_2023_Retrospective_analysis_of_factors_influencing_the.docx | |
License: CC BY 4.0 | |
File access level: Open |
SM3_Bagot_2023_Retrospective_analysis_of_factors_influencing_the.docx | |
License: CC BY 4.0 | |
File access level: Open |
SM4_Bagot_2023_Retrospective_analysis_of_factors_influencing_the.docx | |
License: CC BY 4.0 | |
File access level: Open |
SM5_Bagot_2023_Retrospective_analysis_of_factors_influencing_the.docx | |
License: CC BY 4.0 | |
File access level: Open |
16
total views26
total downloads0
views this month0
downloads this month