Universal versus tailored solutions for alleviating disruptive behavior in hospitals.
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.
Ombudsperson, Department of Management, Rambam Medical Center, Haifa, Israel ; Visiting Research Fellow, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA USA.
Talia
T
Berman-Kishony
Center for Medical Education, Ben-Gurion University of the Negev, Beer Sheva, 84105 Israel.
Shifra
S
Shvarts
Conflict resolution; Disruptive behavior; Nurse-physician conflicts; Patient safety; Patient satisfaction; Quality of care