Understanding how unprofessional behaviour in English NHS Trusts can be prevented and reduced: a mixed-methods study

AIMS AND OBJECTIVES The aim of this research is to help prevent and reduce unprofessional behaviour in the English NHS. Unprofessional behaviour among healthcare staff is common and negatively impacts staff wellbeing and patient outcomes. Unprofessional behaviour in healthcare has been defined broadly in our prior work as ‘any interpersonal behaviour by staff that causes distress or harm to other staff in the healthcare workplace’.[9] It includes incivility, microaggressions, harassment, bullying, sexual harassment and assault. We have five inter-related research questions (RQs): 1. What is the national context around tackling unprofessional behaviour and how do trusts compare on measures of unprofessional behaviour based on routine data, and how does this change over time? 2. What activities and interventions have been introduced in NHS trusts to reduce unprofessional behaviours? 3. By what mechanisms do different activities, organisational structures, processes, and interventions to reduce unprofessional behaviour work at individual, group, profession and organisational levels? 4. In what ways do activities, organisational structures, processes, and interventions to reduce unprofessional behaviours take account of the varying needs of diverse staff groups (e.g. professional groups, women, staff with disabilities, and staff from ethnic minority backgrounds)? 5. How can existing programme theories for understanding unprofessional behaviour be improved and refined, and how might this support the development of more effective interventions to reduce it? METHODS This research builds on a previous HS&DR-funded realist review (Strategies to address unprofessional behaviours among staff in acute healthcare settings: a realist review NIHR131606). We propose a mixed methods realist evaluation using routine data; interviews with key national stakeholders; and in-depth multi-site qualitative case studies (n=8 total) of English NHS organisations which are ‘outliers’ scoring consistently either at the top or bottom of measures of unprofessional behaviour (n=4) and of NHS organisations which are implementing interventions to reduce unprofessional behaviour (n=4). We will explore approaches to reducing and preventing unprofessional behaviour in a variety of ways including documentary analyses, meeting observations and face-to-face theory driven realist interviews. We will test the prior realist framework and guidance developed in this previous study to examine how the framework works in practice. TIMELINES FOR DELIVERY We propose a 24-month project beginning in April 2025. A detailed project plan and timetable are set out in the accompanying Gantt chart. ANTICIPATED IMPACT AND DISSEMINATION We will produce high-impact actionable and accessible findings which will support trusts to prevent and reduce unprofessional behaviour in the NHS. We place a high value on impact and engagement with user communities. We will tailor outputs for different audiences (e.g. healthcare professionals, NHS managers/leaders, training providers, patients and the public and policy makers) to equip them with evidence to support action. Outputs will be co-produced with NHS staff, our experts by experience and PPIE colleagues and include: an animated video; implementation guidance, interactive workshops, infographics, teaching materials, social media, podcasts and blogs; publication in peer reviewed journals; and presentations at conferences, workshops and meetings.