Table 3 Programme theories underpinning the impact of UB on patient safety
From: Drivers of unprofessional behaviour between staff in acute care hospitals: a realist review
Programme theories | Example illustrative data |
|---|---|
CMOC 15. Loss of confidence If unprofessional behaviours are present in a clinical workplace (C) then staff can experience a loss of passion for work (M28/O1) and desire to leave one’s organisation (O2) because UB causes staff to question their self-worth and experience a loss of confidence in one’s abilities (M24) | “… this study suggests that incivility can cause a practitioner to question their actions and ability which can negatively impact on clinical decision- making. Participants suggested that they may ‘take the path of least resistance’” [105] |
CMOC 16. Reduced psychological safety If unprofessional behaviours are present in a clinical workplace (C) it can cause greater incidence of medical errors (O1) and therefore reduced care quality and safety (O2) because presence of UB can lead to reduced psychological safety (M25) which can inhibit ability to speak up when medical errors occur (M21) | “… individuals who engaged with impunity in transgressive or disruptive behaviour—corrupted the conditions of a healthy working environment, resulting in personnel feeling fearful and lacking in psychological safety” [104] |
CMOC 17. Reduced trust in teams If unprofessional behaviours are present in a clinical workplace (C) it can lead to increased clinical errors (O1) and therefore reduced care quality and safety (O2) because UB can reduce trust in teams (M26) or be dishonest to avoid criticism or reprisal (M29) and reduce desire to communicate essential clinical information (M30) | “Incivility caused participants to ruminate on their behaviour to try and find fault with themselves rather than question the negative behaviour of colleagues. A feeling of paranoia is generated, again reducing trust” [13] |
CMOC 18. Impaired concentration and thinking If unprofessional behaviours are present in a clinical workplace (C) it can lead to increased medical errors (O), and a reduced ability to improve one’s skill (O2), causing a reduction in patient safety and care quality (O3) because UB can impair concentration (M27) and cause staff to be distracted while working (M31) | “’…you might be more focused on what’s just happened rather than on the patient themselves and you might miss something on an assessment or treatment [] your mind will not be on the job’” [13] |
CMOC 19. Culture accepting of mistakes If there is an unprofessional environment consistently rife with errors (C) then this can lead to further loss of care quality and safety (O1) because such an environment can cause entrenchment and normalisation of medical errors in the culture (M32) | “This includes surgeons in difficulty blaming others, dismissive of concerns raised about them, and becoming entrenched in their position, sometimes becoming ‘controlling’ or ‘arrogant’ in their approach” [112] |