Impact of unacceptable behaviour between healthcare workers on clinical performance and patient outcomes: a systematic review

Guo, LD (通讯作者),Mater Hlth Serv Brisbane, Adult Intens Care Serv, Brisbane, Qld 4101, Australia.
2022-9
Background Recent studies suggest that displays of unacceptable behaviour, including bullying, discrimination and harassment, between healthcare workers (HCWs) may impair job performance, and in turn, increase the frequency of medical errors, adverse events and healthcare-related complications. The objective of this systematic review was to summarise the current evidence of the impact of unacceptable behaviour occurring between HCWs on clinical performance and patient outcomes. Methods We searched MEDLINE, Embase, PsycINFO and CINAHL from 1 January 1990 to 31 March 2021. The search results were screened by two independent reviewers and studies were included if they were original research that assessed the effects of unacceptable behaviour on clinical performance, quality of care, workplace productivity or patient outcomes. Risk of bias was assessed using tools relevant to the study design and the data were synthesised without meta-analysis. Results From the 2559 screened studies, 36 studies were included: 22 survey-based studies, 4 qualitative studies, 3 mixed-methods studies, 4 simulation-based randomised controlled trials (RCTs) and 3 other study designs. Most survey-based studies were low quality and demonstrated that HCWs perceived a relationship between unacceptable behaviour and worse clinical performance and patient outcomes. This was supported by a smaller number of higher quality retrospective studies and RCTs. Two of four RCTs produced negative results, possibly reflecting inadequate power or study design limitations. No study demonstrated any beneficial effect of unacceptable behaviour on the study outcomes. Conclusions Despite the mixed quality of evidence and some inconsistencies in the strengths of associations reported, the overall weight of evidence shows that unacceptable behaviour negatively affects the clinical performance of HCWs, quality of care, workplace productivity and patient outcomes. Future research should focus on the evaluation and implementation of interventions that reduce the frequency of these behaviours.
BMJ QUALITY & SAFETY
卷号:31|期号:9|页码:679-687
ISSN:2044-5415|收录类别:SCIE
语种
英语
来源机构
Mater Health Services; University of Queensland; Mater Research; University of Queensland; University of Melbourne; University of Queensland; Barts Health NHS Trust; Royal London Hospital; Wollongong Hospital; University of Wollongong; Prince Charles Hospital; George Institute for Global Health; University of New South Wales Sydney; University of Sydney
被引频次(WOS)
4
被引频次(其他)
4
180天使用计数
4
2013以来使用计数
8
EISSN
2044-5423
出版年
2022-9
DOI
10.1136/bmjqs-2021-013955
学科领域
循证公共卫生
关键词
communication diagnostic errors human factors patient safety teamwork
WOS学科分类
Health Care Sciences & Services Health Policy & Services