Background

The pressures of modern healthcare often reduce complex, intimate, care giving relationships into a series of demanding tasks performed under severe time and financial constraints. Even under these conditions, the vast majority of our staff continue to live our values every day and in turn, deliver excellent patient care.

However, we know there are times at SVHA when staff are not treated with respect or worse, are routinely treated with disrespect including emotional abuse, bullying, learning by humiliation, fear, intimidation, ignoring, isolating, yelling, put-downs and humour at others’ expense. These behaviours undermine a culture of safety, contribute to unreliable systems and interfere with healthcare professionals’ and hospitals’ ability to achieve positive clinical outcomes.

Safety efforts such as clinical care bundles, checklists, procedures, protocols and guidelines; staff programs such as well being programs, work health and safety initiatives, and improvement efforts, have achieved a measure of success but not the degree anticipated because, without addressing behaviour, improved systems alone do not optimise safety. There is a growing body of evidence of the link between behaviour and clinical outcomes including:

  • Surgeons who had a high number of patient complaints also had a 14% higher rate of complications following surgery [1]
  • Diagnostic performance was lower for clinical teams exposed to rudeness [2]
  • Poor compliance with hand washing accounts for the development of healthcare associated infections [3]
  • Disruptive behaviours have negative effects on staff (stress, reduced teamwork, loss of concentration) and result in reduced patient satisfaction and increased medical errors and adverse events [4-6]

Achieving safe, reliable, high quality care requires well designed systems and well-functioning teams. External scrutiny of the health sector has indicated that the sector is failing to respond effectively to entrenched cultures and behaviours that put the health and safety of staff and patients at risk. In order to address this, SVHA has committed to a program that acknowledges and rewards staff that live our values, but also responds quickly, equitably and consistently when staff exhibit behaviours that fail to meet the expectations of our organisation.

Purpose

The Ethos program aims to result in a more compassionate and safer healthcare system and is built on three principles; that all staff and patients should feel welcome, valued and safe (Figure 1.)

Figure 1. The Ethos program is underpinned by three principles

The Ethos program allows us to:

  • recognise staff who exhibit positive behaviour and/or are exceptional role models
  • remove barriers to speaking up and make it easier and safer for people to speak up
  • respond quickly and fairly to incidents of behavior that undermine patient and staff safety

For more information go to the Ethos page on the intranet.


  1. Marimuthu K et al. The effect of improved hand hygiene on nosocomial MRSA control. Antimicrobial resistance and infection control. 3:34 Oct 2014.
  2. Cooper W et al. Use of Unsolicited Patient Observations to Identify Surgeons with Increased Risk for Postoperative Complications JAMA Surg. Feb 2017
  3. Riskin A et al. The Impact of Rudeness on Medical Team Performance: A Randomised Trial. American Acad. Paed. June 2015.
  4. Johnson, C., Bad blood: doctor-nurse behavior problems impact patient care. Physician Executive, 2009. 35(6): p. 6-11.
  5. Saxton, R., T. Hines, and M. Enriquez, The Negative Impact of Nurse-Physician Disruptive Behavior on Patient Safety: A Review of the Literature. Journal of Patient Safety, 2009. 5(3): p. 180-183.
  6. Rosenstein, A.H. and M. O'Daniel, Disruptive Behavior & Clinical Outcomes: Perceptions of Nurses & Physicians. The American Journal of Nursing, 2005. 105(1): p. 54-65.