Creating a culture of safety and respect

Creating a culture of safety and respect

A controlled, mixed-methods study of the effectiveness of a behavioural accountability intervention to reduce unprofessional behaviours

This project is funded by a National Health and Medical Research Council Partnership Project - GNT1134459 and St Vincent’s Health Australia.

Project members


Professor Johanna Westbrook
Professor and Director

A/Prof Ling Li
Associate Professor

Dr Ryan McMullan 
Postdoctoral Research Fellow


Dr Rachel Urwin
Research Fellow

Ms Antoinette Pavithra
Research Assistant and PhD Candidate

Professor Jeffrey Braithwaite
Professor and Director


Professor Frances Rapport

Associate Professor Rebecca Mitchell
Associate Professor

Associate Professor Robyn Clay-Williams
Associate Professor


Professor Clifford Hughes AO
Professor of Patient Safety and Clinical Quality

Dr Kate Churruca
Research Fellow

Mr Peter Hibbert
Honorary Associate Professor


Associate Professor Melissa Baysari
Honorary Associate Professor


External Chief Investigators:

Professor Ric Day – UNSW, St Vincent’s Hospital Sydney

Professor Sandy Middleton – Nursing Research Institute

Professor David Scott – St Vincent’s Hospital Melbourne

Dr Natalie Taylor – NSW Cancer Council

St Vincent’s Health Australia partner investigators

Project contact

Dr Rachel Urwin  
T: +61 2 9850 2458

Project main description

Unprofessional behaviour in healthcare is widespread, and significantly undermines the effective functioning of teams, staff wellbeing, patient experience and safety, and organisational productivity. Unprofessional behaviours are associated with higher staff turnover, incidence of patient dissatisfaction, medicolegal risk and significant financial costs. There is a pressing need for evidence-based interventions to reduce the prevalence of negative behaviour, minimise its impact on staff and patients, and normalise a culture of safety and respect.

This project will assess the effectiveness of an innovative structured staff behaviour and escalating accountability intervention, the Ethos program, to be rolled out across St Vincent’s Health Australia hospitals. The study will assess the ability of the Ethos program to reduce unprofessional behaviours, improve the experience of staff, and improve the safety, experience and outcomes of patients. It will also identify enablers and barriers to Ethos program effectiveness and enhance spread and sustainability. The project is a controlled, before and after study using qualitative and quantitative methods – including surveys, interviews, direct observation, HR and patient outcome data linkage.


  1. Westbrook JI, McMullan R, Urwin R, Churruca K, Metri J, Loh E, et al. Changes in unprofessional behaviour, teamwork and co-operation among hospital staff during the COVID-19 pandemic. Intern Med J. 2022;52(10):1821-5.
  2. Pavithra A, Sunderland N, Callen J, Westbrook J. Unprofessional behaviours experienced by hospital staff: qualitative analysis of narrative comments in a longitudinal survey across seven hospitals in Australia. BMC Health Serv Res. 2022;22(1):410.
  3. Pavithra A, Mannion R, Sunderland N, Westbrook J. Speaking up as an extension of socio-cultural dynamics in hospital settings: a study of staff experiences of speaking up across seven hospitals. J Health Organ Manag. 2022;ahead-of-print(ahead-of-print).
  4. Churruca K, Pavithra A, McMullan R, Urwin R, Tippett S, Cunningham N, et al. Creating a culture of safety and respect through professional accountability: case study of the Ethos program across eight Australian hospitals. Aust Health Rev. 2022;46(3):319-24.
  5. Westbrook J, Sunderland N, Li L, Koyama A, McMullan R, Urwin R, et al. The prevalence and impact of unprofessional behaviour among hospital workers: a survey in seven Australian hospitals. Med J Aust. 2021;214(1):31-7.
  6. Pavithra A. Towards developing a comprehensive conceptual understanding of positive hospital culture and approaches to healthcare organisational culture change in Australia. J Health Organ Manag. 2021;ahead-of-print(ahead-of-print).
  7. Westbrook J, Sunderland N, Atkinson V, Jones C, Braithwaite J. Endemic unprofessional behaviour in health care: the mandate for a change in approach. Med J Aust. 2018;209(9):380-1.

Content owner: Australian Institute of Health Innovation Last updated: 30 Nov 2022 2:51pm

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