A £700k NIHR study and £300k national programme.
Project · Professionalism
Understanding and reducing unprofessional behaviour between healthcare staff.
Explaining how harmful workplace behaviours arise, whom they affect and which interventions can create safer NHS cultures.
This programme began with a two-year NIHR HS&DR-funded realist review (NIHR131606) at the University of Surrey, led by Prof Jill Maben, on which I was the sole research fellow. It produced joint first-author papers in BMC Medicine (highlighted as Editor's Choice and in the 96th percentile on Altmetric) and BMC Health Services Research, a 50,000-word NIHR report, and a practical guide for healthcare staff downloaded over 800 times in its first month.
The work has since grown into a wider research stream: a typology of unprofessional behaviours, a behavioural-science analysis of 44 interventions, and two major new grants — a £700k NIHR mixed-methods study on preventing and reducing unprofessional behaviour in English NHS Trusts (Co-Investigator), and a £300k NHS Race and Health Observatory project on addressing racialised bullying and harassment in the NHS, which I lead as Principal Investigator.
Evidence at a glance
Realist, behavioural and practice-focused evidence.
In the first month after publication.
Outputs
Publications so far
Formulating a typology of unprofessional behaviours between healthcare staff to improve intervention effectiveness: a best fit framework synthesisFirst author
2026 · Aunger JA, Abrams R, Mannion R, Jones A, Wright JM, Westbrook JI, Pearson M, Maben J · BMC Health Services Research
What drives unprofessional behaviour in healthcare?First author
2026 · Aunger JA, Maben J, Westbrook J, Wright J, Pearson M, Jones A, Mannion R · Nursing Times
Addressing unprofessional behaviour in the NHS
2026 · Mannion R, Ferguson J, Aunger J, Maben J · British Journal of Healthcare Management
Systematically analysing behaviour change techniques used in 44 interventions to reduce unprofessional behaviour between healthcare staffFirst author
2025 · Aunger JA, Ungureanu B, Maben J, Abrams R, Turner AM, Westbrook JI · Translational Behavioral Medicine
How unprofessional behaviours between healthcare staff threaten patient care and safetyFirst author
2025 · Aunger JA, Maben J, Westbrook JI · Expert Review of Pharmacoeconomics & Outcomes Research
Why do acute healthcare staff behave unprofessionally towards each other and how can these behaviours be reduced? A realist reviewFirst author
2024 · Aunger JA, Abrams R, Westbrook JI, Wright JM, Pearson M, Jones A, Mannion R, Maben J · NIHR Health and Social Care Delivery Research Journal
How can interventions more directly address drivers of unprofessional behaviour between healthcare staff?First author
2024 · Aunger JA, Abrams R, Mannion R, Westbrook JI, Jones A, et al. · BMJ Open Quality
Interventions to address unprofessional behaviours between staff in acute care: what works for whom and why? A realist reviewJoint first author
2023 · Maben J*, Aunger JA*, Abrams R, Wright JM, Pearson M, et al. · BMC Medicine — Editor's Choice, 96th percentile on Altmetric
Drivers of unprofessional behaviour between staff in acute care hospitals: a realist reviewJoint first author
2023 · Aunger JA*, Maben J*, Abrams R, Wright JM, et al. · BMC Health Services Research — BMC Series Highlight
Why do acute healthcare staff engage in unprofessional behaviours towards each other and how can these behaviours be reduced? A realist review protocol
2022 · Maben J, Aunger JA, Abrams R, Pearson M, et al. · BMJ Open
Funding
Grants in this programme
- 2025Addressing racialised bullying and harassment in the NHS — £300k, Principal Investigator
- 2024Understanding how unprofessional behaviour in English NHS Trusts can be prevented and reduced: a mixed-methods study — £700k, Co-InvestigatorNIHR HS&DR
- 2021 — 2023Strategies to address unprofessional behaviours among staff in acute healthcare settings: a realist review — sole research fellowNIHR HS&DR (NIHR131606) · University of Surrey
Impact
Reach beyond academia
- 2026Invited guest on NHS Race and Health Observatory Podcast: Race and Health Matters
- 2025Invited panellist at NHS Employers "Disability Summit" on psychological safety
- 2024Published guide for addressing unprofessional behaviours between healthcare staff — 800+ downloads in the first month
- 2024Invited speaker at University Hospitals Birmingham "Freedom to Speak Up" day, alongside Prof Mary Dixon-Woods and others
- 2024Presentations to ~200 HR/OD NHS employees ("Big Coffee Break") and to NHS HR professionals at Frimley ICS and wider
- 2023Workshops with NHS Trusts including Great Western NHS FT on reducing unprofessional behaviours
- 2023YQSR Seminar on findings from the realist review
- 2023Publication selected as a BMC Series Highlight
Continue exploring
See how the same combination of realist explanation and practical translation runs through the wider portfolio.
Methods
How behavioural science strengthens realist research
The methods behind more precise programme theories.
→ ImpactFrom evidence to change in NHS practice
Workshops, guidance, media and policy engagement.
→ CollaborateDiscuss a research partnership
Get in touch about culture, behaviour or patient safety.
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