Healthcare Workers' Perceptions of Unprofessional Behavior in the Hospital: A Descriptive Content Analysis of Safety Event Reports

Unprofessional behavior undermines organizational safety culture and is a threat to patient safety and healthcare worker well-being. Understanding the behaviors that healthcare workers perceive as unprofessional, based on reports submitted via the safety event reporting system, provides potential targets for promoting a culture of safety.

This directed content analysis examined all safety event reports categorized as unprofessional behavior over a 12-month period (July 2021-June 2022) at a single 1,180-bed academic medical center in the northeastern United States. The authors quantified the frequency and roles of healthcare workers who report perceived unprofessional behavior (reporters) and who are reported for unprofessional behavior (reportees), and described themes from the narrative summaries of these reports.

A total of 836 event reports of unprofessional behavior were analyzed. Nurses were the most frequent reporters (442, 52.9%), followed by resident and fellow physicians (105, 12.6%). Nurses were the most common reportees (193, 23.1%), followed by resident and fellow physicians (121,14.5%) and attending physicians (101, 12.1%) Reports of unprofessional behavior were characterized by four main themes: communication (750, 89.7%), responsibility (565, 67.6%), integrity (101, 12.1%), and harassment and discrimination (38, 4.5%). Approximately two-thirds (63.0%) of unprofessionalism reports described interactions between members of different clinical departments or units.

Two- thirds of hospital safety event reports about unprofessional behavior describe another individuals' poor communication, failure or delay in completing a role-related responsibility, or both. More than half involve healthcare workers from different departments or clinical areas. Interventions to reduce unprofessional behavior should focus on developing accountability infrastructure, training in conflict management across disciplines, and systematic strategies to identify and intervene within areas that experience frequent friction.