Table 1 Sources of data and their role in analysis of implementation of Ethos

 1. Program information and implementation plan

Early (2017)

11-page document developed by the Group that provides background on the program, the need for it, the components of Ethos, and high-level plans for its implementation.

Analysis: Coded to the CFIR.

 2. Independent review of Ethos program in two hospitals

Early to mid (March - July 2019)

14-page report of an independent review into Ethos at two sites first to implement (one public, one private). Review was commissioned by the Group Ethos steering committee and aimed to identify elements working well and areas for improvement.

Analysis: Coded to the CFIR.

Empirical data collection

 3. Baseline survey of all staff [4]

Early (December 2017 – November 2018)

Sampling: All staff from seven hospitals prior to implementing Ethos were invited to undertake a survey about their experiences of unprofessional behaviours. Response rate was 34% (n = 5,178).

Collection: Included closed and open response questions on experience of unprofessional behaviour in the preceding 12 months. Further details on the survey are provided elsewhere [4, 13].

Analysis: Only open responses to questions about unprofessional behaviour and behaviour in general within the hospital were analysed. 32% of respondents (n = 1,636) answered at least one of these open questions. Responses coded to the CFIR.

 4. Interviews with senior hospital leadership

Early to mid (November 2018)

Sampling: Interviews (n = 15) with all consenting executives from the two sites (one public, one private) that were first to implement Ethos.

Collection: Interview schedule covered views on unprofessional behaviour in the hospitals and the Ethos program along with their perspectives on the results of the baseline survey results.

Analysis: Transcribed and coded to the CFIR.

 5. Survey of Ethos peer messengers

Mid (October – November 2020)

Sampling: All current and previous Ethos peer messengers from eight sites invited to take part. There were 60 respondents (response rate 41.5%).

Collection: Survey asked open and closed response questions about reasons for taking on the role, experiences of the program, training, support, challenges. Further details on the survey are provided elsewhere [34].

Analysis: Open responses coded to the CFIR.

 6. Interviews with middle managers

Mid to late (August 2020 – May 2021)

Sampling: Purposive sampling of n = 30 middle managers from five sites to explore unprofessional behaviours and the Ethos program. Participants were clinical (nursing = 12, medicine = 8) and support services (n = 10) and some had formal roles within Ethos (e.g., trainers).

Collection: Interview schedule covered descriptions of unprofessional behaviour experienced and raising by staff and how middle managers responded to these concerns, and views about the Ethos program.

Analysis: Interview recordings were transcribed and inductively coded; code on “implementation” was extracted for this analysis and recoded to the CFIR.