Incivility experiences of racially minoritised hospital staff, consequences for them and implications for patient care: An international scoping review.

Workplace incivility is a pervasive complex problem within health care. Incivility manifests as subtle disrespectful behaviours, which seem inconsequential. However, evidence demonstrates that incivility can be harmful to targets and witnesses through negative emotions, poorer mental health, reduced job satisfaction, diminished performance and compromised patient care. It is unclear to what extent existing research critically explores how ethnicity, culture and racism influence how hospital staff experience incivility. This global scoping review systematically analysed existing research exploring the specific ways incivility manifests and impacts racially minoritised hospital workers. Of 2636 academic and 101 grey literature articles, 32 were included. Incivility experiences were categorised into four themes: (1) Cultural control, (2) Rejection of work contributions, (3) Disempowerment at work and (4) Managerial indifference. The included articles highlighted detrimental consequences, such as negative emotions, silencing, withdrawal and reduced support-seeking behaviours. Few studies presented evidence regarding the negative impacts of incivility on patient care. Racialisation and racial dynamics are a significant factor for hospital-based incivility. Currently we do not know the extent to which racialised incivility is associated directly or, perhaps either via burnout or disengagement, indirectly with poorer care. This knowledge can inform the creation of comprehensive, evidence-based interventions to address this important issue.

The Association Between Health Care Staff Engagement and Patient Safety Outcomes: A Systematic Review and Meta-Analysis.

OBJECTIVES: Despite decades of research, improving health care safety remains a global priority. Individual studies have demonstrated links between staff engagement and care quality, but until now, any relationship between engagement and patient safety outcomes has been more speculative. This systematic review and meta-analysis therefore assessed this relationship and explored if the way these variables were defined and measured had any differential effect. METHODS: After systematic searches of Medline, CINAHL, PsycInfo, Embase, Cochrane Library, and National Institute for Health Research Journals databases, narrative and random-effects meta-analyses were completed, with pooled effect sizes expressed as Pearson r. RESULTS: Fourteen studies met the inclusion criteria, 11 of which were suitable for meta-analysis. Meta-analyses indicated a small but consistent, statistically significant relationship between staff engagement and patient safety (all outcomes; 11 studies; r = 0.22; 95% confidence interval [CI], 0.07 to 0.36; n = 30,490) and 2 patient safety outcome categories: patient safety culture (7 studies; r = 0.22; 95% CI, 0.01 to 0.41; n = 27,857) and errors/adverse events (4 studies; r = -0.20; 95% CI, -0.26 to -0.13; n = 2633). The specific approach to conceptualizing engagement did not affect the strength of the findings. CONCLUSIONS: This is the first review to demonstrate a significant relationship between engagement and both safety culture scores and errors/adverse events. Despite a limited and evolving evidence base, we cautiously conclude that increasing staff engagement could be an effective means of enhancing patient safety. Further research is needed to determine causality and clarify the nature of the staff engagement/patient safety relationship at individual and unit/workgroup levels.

Judgments of the rule-related behaviour of health care professionals: An experimental study.

OBJECTIVES: To explore the judgments of rule-related behaviour by health care professionals and the general public in the UK, against a background in which clinical guidelines and protocols are proliferating. DESIGN: A questionnaire survey was used in which short scenarios describing medical practice were presented to a sample of health care professionals and members of the general public. METHODS: The health care sample consisted of 315 nurses, doctors and midwives from three English National Health Service (NHS) Trusts who volunteered to take part in the study. A stratified sample of members of the general public (N = 350) was recruited via a market research organization. Three types of behaviour (compliance with a protocol, violation of a protocol, and improvization, where no protocol exists) and three types of outcome for the patient (good, bad, poor) were manipulated within nine scenarios. Respondents were asked to make judgments about (1) the inappropriateness of behaviour (2) likelihood that they would take further action and (3) responsibility for the outcome. RESULTS: Findings suggest that the process of care has a greater effect on judgments of the behaviour of health care professionals than does the outcome of that behaviour. This was equally true of the professional and public samples. CONCLUSIONS: The study has both theoretical and practical implications. First, information about a behaviour's relationship to existing rules has a stronger influence than the consequence of the behaviour on attributions of responsibility. Secondly, using clinical protocols as a way of managing risk in the NHS may be counterproductive unless full compliance is achieved.