How unprofessional behaviours between healthcare staff threaten patient care and safety

Introduction: Unprofessional behaviors (UB) such as bullying and incivility among healthcare staff are a significant and pervasive issue, impacting staff wellbeing, and patient safety and experiences of care. Despite its prevalence, misconceptions persist regarding the impact of UB and the mechanisms through which it affects patients. 

Areas covered: We draw upon evidence including outcomes from an extensive realist review and empirical research, to demonstrate the impacts of UB on patient safety and experience, particularly focusing on how even mild forms of incivility can compromise care quality. Recent research demonstrates a correlation between UB among healthcare professionals and reduced performance, increased medical errors, compromised safety culture, and inequities in patient outcomes. Additionally, we highlight the disproportionate impact of UB on minoritised staff and its resulting effects on patient care, which has the potential to perpetuate healthcare inequities via reducing staff diversity. 

Expert opinion: Emerging evidence indicates that subtle UB such as incivility and undermining may be more damaging to patient outcomes than previously acknowledged. Addressing UB requires effective, tailored interventions, especially considering the disproportionate impact on diverse healthcare teams. Urgently combating UB is required to not only enhance patient safety but also to improve equity in care in healthcare systems worldwide.