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Table 3 Facilitators and Barriers to using the Ethos Program

From: Middle manager responses to hospital co-workers’ unprofessional behaviours within the context of a professional accountability culture change program: a qualitative analysis

Theme

Facilitators

Barriers

Individual

Anonymous

Concerned they are identifiable

System for those not confident speaking up directly

Sometimes do not know required details (e.g., name of perpetrator)

Others can submit messages

Low awareness of how it works

Removes work for the manager

Prefer to speak directly to perpetrator

System

Removes power imbalance

Technology / intra-net based, forget how to access, password

Provides structure and processes

No right of reply, one-sided

Informal, non-punitive

Don’t know if action is taken or not

Peer, not colleague or junior, provides feedback

Mocked, used as a threat

Effectiveness

Identified hidden issues for managers

Behaviour has not improved

Perpetrators not realising impact until received message, behaviour improved

Outcome not guaranteed

Training in how to conduct difficult conversations

Management behaviour, not unprofessional behaviour

Positive messages have a strong positive impact on recipients

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