Investigating what leads to harmful or distressing interactions (‘unprofessional behaviours’) between co-workers in healthcare, and what we can do about it

Between 2021 and 2023, researchers undertook an extensive realist review of the evidence, drawing on 148 UK and international sources, including reports of 42 interventions. The review aimed to answer two questions: ‘What leads to unprofessional behaviours taking place?’ and ‘What can we do about it?’. The research focused on acute settings, but many of the findings are relevant to other healthcare environments.


A quick guide highlighting the key findings and recommendations

Read our conditions for downloading the guide here

The guide

We are happy to provide this free of charge, but would ask you to consider the following conditions for its use:

  • Please do not distribute this to anyone else – if anyone asks for a copy please ask them to obtain it via this website. This will enable us to track downloads and engagement which is crucial for us to measure the impact of our research.

If you use the guidance, or any part of it, we would be grateful if you would please:

  • Acknowledge the authorship team;
  • Send copies of any reports/papers that are produced to Professor Jill Maben ( or Professor Cath Taylor
  • Let us have any comments/suggestions that you feel might improve the guidance so that your experience can be incorporated into subsequent updates.


Click to download


Recording of a presentation delivered to HSRUK in June 2023
Click to view


Recording of event launching guidance for unprofessional behaviours
Click to view


The full NIHR research report
Coming soon

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