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Universal versus tailored solutions for alleviating disruptive behavior in hospitals.

Berman-Kishony T, Shvarts S - Isr J Health Policy Res (2015)

Bottom Line: These outcomes were correlated by the antecedents to disruptive behavior, which in turn affected the effectiveness of alleviating strategies and tools.Some tools, such as processes for evaluating complaints, teamwork and conflict management courses, and introducing a behavioral mission statement, are effective across many antecedents.Conflict resolution tools and strategies, based on residents and nurse perceptions, may be more effective if tailored to the specific situation, rather than using a "one-size-fits-all" approach.

View Article: PubMed Central - PubMed

Affiliation: Ombudsperson, Department of Management, Rambam Medical Center, Haifa, Israel ; Visiting Research Fellow, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA USA.

ABSTRACT

Background: Disruptive behavior among hospital staff can negatively affect quality of care. Motivated by a standard on disruptive behavior issued by The Joint Commission (LD 3.10), as well as the desire to improve patient care, minimize liability, and improve staff retention, hospitals are setting policies to prevent and resolve disruptive behaviors. However, it is unknown whether uniform conflict management tools are equally effective among different hospital settings.

Methods: We surveyed residents and nurses to identify similarities and differences among hospital departments in the antecedents, characteristics, and outcomes of disruptive behaviors, and in the effectiveness of conflict management tools. We used a quantitative questionnaire-based assessment to examine conflict perceptions in eight different hospital departments at Rambam Medical Center in Haifa, Israel.

Results: Most participants (89 %) reported witnessing disruptive behavior either directly or in other parties; the most significant causes were identified as intense work, miscommunication, and problematic personalities. The forms of these behaviors, however, varied significantly between departments, with some more prone to expressed conflicts, while others were characterized by hidden disruptive behaviors. These outcomes were correlated by the antecedents to disruptive behavior, which in turn affected the effectiveness of alleviating strategies and tools. Some tools, such as processes for evaluating complaints, teamwork and conflict management courses, and introducing a behavioral mission statement, are effective across many antecedents. Other tools, however, are antecedent-specific, falling into two principal categories: tools directly removing a specific problem and tools that offer a way to circumvent the problem.

Conclusions: Conflict resolution tools and strategies, based on residents and nurse perceptions, may be more effective if tailored to the specific situation, rather than using a "one-size-fits-all" approach.

No MeSH data available.


Related in: MedlinePlus

Forms of disruptive behavior. a Average scores of questionnaire on a scale of 1–5 for different forms of disruptive behaviors, for all participants (grey) and dissected by department (color, see legend; LD: Labor and Delivery, ICU: Intensive Care Unit, ER: Emergency Room, ECU: Emergency Care Unit). Error bars represnt standard error of the mean (standard deviation divided by square root of number of participants). b Clustering algorithm (left dendogram) applied to the correlation matrix between each two Forms of disruptive behavior (color-map represent the correlation; red – high correlation, yellow- low correlation) reveals natural grouping of the forms into ‘Hidden’, ‘Expressed’ and other more ‘Sophisticated’ forms. See text for more details
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Fig1: Forms of disruptive behavior. a Average scores of questionnaire on a scale of 1–5 for different forms of disruptive behaviors, for all participants (grey) and dissected by department (color, see legend; LD: Labor and Delivery, ICU: Intensive Care Unit, ER: Emergency Room, ECU: Emergency Care Unit). Error bars represnt standard error of the mean (standard deviation divided by square root of number of participants). b Clustering algorithm (left dendogram) applied to the correlation matrix between each two Forms of disruptive behavior (color-map represent the correlation; red – high correlation, yellow- low correlation) reveals natural grouping of the forms into ‘Hidden’, ‘Expressed’ and other more ‘Sophisticated’ forms. See text for more details

Mentions: The frequency of disruptive behaviors varied substantially, with verbal abuse being the most prevalent (Fig. 1a). A large fraction of the respondents noted that they were witness to disruptive behavior (89 %). The most commonly reported form of disruptive behavior was yelling, followed by inappropriate joking and then, degrading comments and insults and spreading malicious rumors. Refusing to work and talk with colleagues was less frequent. Cursing and trying to get someone unjustly fired was reported to be rare.Fig. 1


Universal versus tailored solutions for alleviating disruptive behavior in hospitals.

Berman-Kishony T, Shvarts S - Isr J Health Policy Res (2015)

Forms of disruptive behavior. a Average scores of questionnaire on a scale of 1–5 for different forms of disruptive behaviors, for all participants (grey) and dissected by department (color, see legend; LD: Labor and Delivery, ICU: Intensive Care Unit, ER: Emergency Room, ECU: Emergency Care Unit). Error bars represnt standard error of the mean (standard deviation divided by square root of number of participants). b Clustering algorithm (left dendogram) applied to the correlation matrix between each two Forms of disruptive behavior (color-map represent the correlation; red – high correlation, yellow- low correlation) reveals natural grouping of the forms into ‘Hidden’, ‘Expressed’ and other more ‘Sophisticated’ forms. See text for more details
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4556051&req=5

Fig1: Forms of disruptive behavior. a Average scores of questionnaire on a scale of 1–5 for different forms of disruptive behaviors, for all participants (grey) and dissected by department (color, see legend; LD: Labor and Delivery, ICU: Intensive Care Unit, ER: Emergency Room, ECU: Emergency Care Unit). Error bars represnt standard error of the mean (standard deviation divided by square root of number of participants). b Clustering algorithm (left dendogram) applied to the correlation matrix between each two Forms of disruptive behavior (color-map represent the correlation; red – high correlation, yellow- low correlation) reveals natural grouping of the forms into ‘Hidden’, ‘Expressed’ and other more ‘Sophisticated’ forms. See text for more details
Mentions: The frequency of disruptive behaviors varied substantially, with verbal abuse being the most prevalent (Fig. 1a). A large fraction of the respondents noted that they were witness to disruptive behavior (89 %). The most commonly reported form of disruptive behavior was yelling, followed by inappropriate joking and then, degrading comments and insults and spreading malicious rumors. Refusing to work and talk with colleagues was less frequent. Cursing and trying to get someone unjustly fired was reported to be rare.Fig. 1

Bottom Line: These outcomes were correlated by the antecedents to disruptive behavior, which in turn affected the effectiveness of alleviating strategies and tools.Some tools, such as processes for evaluating complaints, teamwork and conflict management courses, and introducing a behavioral mission statement, are effective across many antecedents.Conflict resolution tools and strategies, based on residents and nurse perceptions, may be more effective if tailored to the specific situation, rather than using a "one-size-fits-all" approach.

View Article: PubMed Central - PubMed

Affiliation: Ombudsperson, Department of Management, Rambam Medical Center, Haifa, Israel ; Visiting Research Fellow, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA USA.

ABSTRACT

Background: Disruptive behavior among hospital staff can negatively affect quality of care. Motivated by a standard on disruptive behavior issued by The Joint Commission (LD 3.10), as well as the desire to improve patient care, minimize liability, and improve staff retention, hospitals are setting policies to prevent and resolve disruptive behaviors. However, it is unknown whether uniform conflict management tools are equally effective among different hospital settings.

Methods: We surveyed residents and nurses to identify similarities and differences among hospital departments in the antecedents, characteristics, and outcomes of disruptive behaviors, and in the effectiveness of conflict management tools. We used a quantitative questionnaire-based assessment to examine conflict perceptions in eight different hospital departments at Rambam Medical Center in Haifa, Israel.

Results: Most participants (89 %) reported witnessing disruptive behavior either directly or in other parties; the most significant causes were identified as intense work, miscommunication, and problematic personalities. The forms of these behaviors, however, varied significantly between departments, with some more prone to expressed conflicts, while others were characterized by hidden disruptive behaviors. These outcomes were correlated by the antecedents to disruptive behavior, which in turn affected the effectiveness of alleviating strategies and tools. Some tools, such as processes for evaluating complaints, teamwork and conflict management courses, and introducing a behavioral mission statement, are effective across many antecedents. Other tools, however, are antecedent-specific, falling into two principal categories: tools directly removing a specific problem and tools that offer a way to circumvent the problem.

Conclusions: Conflict resolution tools and strategies, based on residents and nurse perceptions, may be more effective if tailored to the specific situation, rather than using a "one-size-fits-all" approach.

No MeSH data available.


Related in: MedlinePlus