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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

Factors causing disruptive behavior. Average scores of questionnaire on a scale of 1–5 for different Antecedents 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 are calculated as explained in Fig. 1
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Fig3: Factors causing disruptive behavior. Average scores of questionnaire on a scale of 1–5 for different Antecedents 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 are calculated as explained in Fig. 1

Mentions: The highest reported causes for disruptive behavior were “aggressive conflict-prone personality”, “intense, stressful and high workloads”, “poor communication”, “distrust and disrespect” (Fig. 3). These high scoring factors represent personal, interpersonal and organizational factors, respectively. These results, therefore, rated the importance of personality of participants, as well as the work environment as structured by the organization and colleagues. At second, but still high level, we find the factors of interdependence, lack of professional and personal acquaintance, lack of supervision from the nurse manager and the department head, disagreements over medical management as well as insufficient opportunities for informal interactions to cause conflicts. Ethnicity difference was the least influential source of conflict.Fig. 3


Universal versus tailored solutions for alleviating disruptive behavior in hospitals.

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

Factors causing disruptive behavior. Average scores of questionnaire on a scale of 1–5 for different Antecedents 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 are calculated as explained in Fig. 1
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig3: Factors causing disruptive behavior. Average scores of questionnaire on a scale of 1–5 for different Antecedents 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 are calculated as explained in Fig. 1
Mentions: The highest reported causes for disruptive behavior were “aggressive conflict-prone personality”, “intense, stressful and high workloads”, “poor communication”, “distrust and disrespect” (Fig. 3). These high scoring factors represent personal, interpersonal and organizational factors, respectively. These results, therefore, rated the importance of personality of participants, as well as the work environment as structured by the organization and colleagues. At second, but still high level, we find the factors of interdependence, lack of professional and personal acquaintance, lack of supervision from the nurse manager and the department head, disagreements over medical management as well as insufficient opportunities for informal interactions to cause conflicts. Ethnicity difference was the least influential source of conflict.Fig. 3

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