Midlands Patient Safety Research Collaboration, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
BMJ Open Qual. 2024 Jul 8;13(3):e002830. doi: 10.1136/bmjoq-2024-002830.
Unprofessional behaviours (UBs) between healthcare staff are widespread and have negative impacts on patient safety, staff well-being and organisational efficiency. However, knowledge of how to address UBs is lacking. Our recent realist review analysed 148 sources including 42 reports of interventions drawing on different behaviour change strategies and found that interventions insufficiently explain their rationale for using particular strategies. We also explored the drivers of UBs and how these may interact. In our analysis, we elucidated both common mechanisms underlying both how drivers increase UB and how strategies address UB, enabling the mapping of strategies against drivers they address. For example, social norm-setting strategies work by fostering a more professional social norm, which can help tackle the driver 'reduced social cohesion'. Our novel programme theory, presented here, provides an increased understanding of what strategies might be effective to adddress specific drivers of UB. This can inform logic model design for those seeking to develop interventions addressing UB in healthcare settings.
医护人员之间的不专业行为(UBs)普遍存在,对患者安全、员工福祉和组织效率都有负面影响。然而,人们对如何解决 UBs 的知识还很缺乏。我们最近的一项现实主义综述分析了 148 个来源,包括 42 份利用不同行为改变策略的干预报告,发现这些干预措施没有充分解释其使用特定策略的基本原理。我们还探讨了 UBs 的驱动因素以及这些因素如何相互作用。在我们的分析中,我们阐明了驱动因素增加 UB 和策略解决 UB 的共同机制,从而可以根据它们所针对的驱动因素来映射策略。例如,社会规范制定策略通过培养更专业的社会规范来发挥作用,这有助于解决“社会凝聚力降低”这一驱动因素。我们在这里提出的新方案理论,提供了对哪些策略可能对解决 UB 的特定驱动因素有效的更多理解。这可以为那些希望在医疗保健环境中开发针对 UB 的干预措施的人提供逻辑模型设计的信息。