Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
BMC Health Serv Res. 2020 Dec 4;20(1):1123. doi: 10.1186/s12913-020-05974-0.
Broken windows theory (BWT) proposes that visible signs of crime, disorder and anti-social behaviour - however minor - lead to further levels of crime, disorder and anti-social behaviour. While we acknowledge divisive and controversial policy developments that were based on BWT, theories of neighbourhood disorder have recently been proposed to have utility in healthcare, emphasising the potential negative effects of disorder on staff and patients, as well as the potential role of collective efficacy in mediating its effects. The aim of this study was to empirically examine the relationship between disorder, collective efficacy and outcome measures in hospital settings. We additionally sought to develop and validate a survey instrument for assessing BWT in hospital settings.
Cross-sectional survey of clinical and non-clinical staff from four major hospitals in Australia. The survey included the Disorder and Collective Efficacy Survey (DaCEs) (developed for the present study) and outcome measures: job satisfaction, burnout, and patient safety. Construct validity was evaluated by confirmatory factor analysis (CFA) and reliability was assessed by internal consistency. Structural equation modelling (SEM) was used to test a hypothesised model between disorder and patient safety and staff outcomes.
The present study found that both social and physical disorder were positively related to burnout, and negatively related to job satisfaction and patient safety. Further, we found support for the hypothesis that the relationship from social disorder to outcomes (burnout, job satisfaction, patient safety) was mediated by collective efficacy (social cohesion, willingness to intervene).
As one of the first studies to empirically test theories of neighbourhood disorder in healthcare, we found that a positive, orderly, productive culture is likely to lead to wellbeing for staff and the delivery of safer care for patients.
破窗理论（BWT）认为，犯罪、混乱和反社会行为的可见迹象——无论多么微小——都会导致进一步的犯罪、混乱和反社会行为。虽然我们承认基于 BWT 的有争议的政策发展，但最近提出的邻里混乱理论在医疗保健方面具有实用性，强调了混乱对员工和患者的潜在负面影响，以及集体效能在调节其影响方面的潜在作用。本研究旨在实证检验医院环境中混乱、集体效能和结果测量之间的关系。我们还试图开发和验证一种用于评估医院环境中 BWT 的调查工具。
对澳大利亚四家大医院的临床和非临床工作人员进行横断面调查。该调查包括混乱和集体效能调查（DaCEs）（为本研究开发）和结果测量：工作满意度、倦怠和患者安全。构念效度通过验证性因素分析（CFA）进行评估，信度通过内部一致性进行评估。结构方程模型（SEM）用于测试混乱与患者安全和员工结果之间的假设模型。
本研究发现，社会和物理混乱都与倦怠呈正相关，与工作满意度和患者安全呈负相关。此外，我们发现支持这样的假设，即社会混乱与结果（倦怠、工作满意度、患者安全）之间的关系是由集体效能（社会凝聚力、干预意愿）介导的。
作为首批实证检验医疗保健中邻里混乱理论的研究之一，我们发现积极、有序、富有成效的文化很可能导致员工的幸福感和为患者提供更安全的护理。
