Rehder Kyle J, Adair Kathryn C, Hadley Allison, McKittrick Katie, Frankel Allan, Leonard Michael, Frankel Terri Christensen, Sexton J Bryan
Jt Comm J Qual Patient Saf. 2020 Jan;46(1):18-26. doi: 10.1016/j.jcjq.2019.09.004. Epub 2019 Nov 6.
Disruptive and unprofessional behaviors occur frequently in health care and adversely affect patient care and health care worker job satisfaction. These behaviors have rarely been evaluated at a work setting level, nor do we fully understand how disruptive behaviors (DBs) are associated with important metrics such as teamwork and safety climate, work-life balance, burnout, and depression.
Using a cross-sectional survey of all health care workers in a large US health system, this study aimed to introduce a brief scale for evaluating DBs at a work setting level, evaluate the scale's psychometric properties and provide benchmarking prevalence data from the health care system, and investigate associations between DBs and other validated measures of safety culture and well-being.
One or more of six DBs were reported by 97.8% of work settings. DBs were reported in similar frequencies by men and women, and by most health care worker roles. The six-item disruptive behavior scale demonstrated an internal consistency of α = 0.867. DB climate was significantly correlated with poorer teamwork climate, safety climate, job satisfaction, and perceptions of management; lower work-life balance; increased emotional exhaustion (burnout); and increased depression (p < 0.001 for each). A 10-unit increase in DB climate was associated with a 3.89- and 3.83-point decrease in teamwork and safety climate, respectively, and a 3.16- and 2.42-point increase in burnout and depression, respectively.
Disruptive behaviors are common, measurable, and associated with safety culture and health care worker well-being. This concise DB scale affords researchers a new, valid, and actionable tool to assess DBs.
破坏性行为和不专业行为在医疗保健领域频繁发生，对患者护理和医护人员的工作满意度产生不利影响。这些行为很少在工作场所层面进行评估，我们也不完全了解破坏性行为（DBs）与团队合作、安全氛围、工作与生活平衡、职业倦怠和抑郁等重要指标之间的关联。
通过对美国一个大型医疗系统中的所有医护人员进行横断面调查，本研究旨在引入一种用于在工作场所层面评估破坏性行为的简短量表，评估该量表的心理测量特性，并提供来自该医疗系统的基准患病率数据，同时调查破坏性行为与其他经过验证的安全文化和幸福感测量指标之间的关联。
97.8%的工作场所报告了六种破坏性行为中的一种或多种。男性和女性以及大多数医护人员角色报告破坏性行为的频率相似。六项破坏性行为量表的内部一致性为α = 0.867。破坏性行为氛围与较差的团队合作氛围、安全氛围、工作满意度和对管理层的看法显著相关；工作与生活平衡度较低；情绪耗竭（职业倦怠）增加；抑郁增加（每项p < 0.001）。破坏性行为氛围每增加10个单位，团队合作氛围和安全氛围分别下降3.89分和3.83分，职业倦怠和抑郁分别增加3.16分和2.42分。
破坏性行为很常见、可测量，且与安全文化和医护人员的幸福感相关。这种简洁的破坏性行为量表为研究人员提供了一种新的、有效的且可操作的工具来评估破坏性行为。
