Berman-Kishony Talia, Shvarts Shifra
Ombudsperson, Department of Management, Rambam Medical Center, Haifa, Israel ; Visiting Research Fellow, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA USA.
Center for Medical Education, Ben-Gurion University of the Negev, Beer Sheva, 84105 Israel.
Isr J Health Policy Res. 2015 Sep 1;4:26. doi: 10.1186/s13584-015-0018-7. eCollection 2015.
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.
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.
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.
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.
医院工作人员的破坏性行为会对医疗质量产生负面影响。受联合委员会发布的破坏性行为标准（LD 3.10）的推动，以及改善患者护理、将责任风险降至最低和提高员工留用率的愿望，医院正在制定政策以预防和解决破坏性行为。然而，尚不清楚统一的冲突管理工具在不同医院环境中是否同样有效。
我们对住院医师和护士进行了调查，以确定医院各科室在破坏性行为的前因、特征和后果以及冲突管理工具的有效性方面的异同。我们使用基于问卷的定量评估方法，对以色列海法兰巴姆医疗中心的八个不同医院科室的冲突认知进行了研究。
大多数参与者（89%）报告称直接目睹或在其他场合目睹过破坏性行为；最主要的原因被确定为工作强度大、沟通不畅和性格问题。然而，这些行为的形式在不同科室之间有很大差异，有些科室更容易出现显性冲突，而其他科室则以隐性破坏性行为为特征。这些结果与破坏性行为的前因相关，而前因又反过来影响缓解策略和工具的有效性。一些工具，如投诉评估流程、团队合作和冲突管理课程以及引入行为使命宣言，在许多前因情况下都有效。然而，其他工具则是针对特定前因的，分为两个主要类别：直接消除特定问题的工具和提供规避问题方法的工具。
根据住院医师和护士的认知，冲突解决工具和策略如果根据具体情况量身定制，可能会比采用“一刀切”的方法更有效。
