Fujimoto Manabu, Shimamura Mika, Miyazaki Hiroaki
Institute for Teaching and Learning, Ritsumeikan University, 56-1 Tojiin-Kitamachi, Kita-ku, Kyoto 603-8577, Japan.
Faculty of Nursing, Reiwa Health Sciences University, 2-1-12 Wajirogaoka, Higashi-ku, Fukuoka 811-0213, Japan.
Healthcare (Basel). 2025 Feb 26;13(5):510. doi: 10.3390/healthcare13050510.
Disruptive clinician behavior (DCB) negatively affects patient safety by impairing healthcare team communication. In Japanese hospitals, hierarchical structures and traditional leadership styles contribute to its persistence. This study examines the prevalence and impact of DCB in two general hospitals and evaluates the role of response strategies in mitigating its effects. A quantitative web-based survey was conducted among 256 healthcare professionals from two general hospitals (751 and 661 beds). The survey included demographic data, a validated DCB scale, and a structured questionnaire assessing triggers, responses, and impacts. Statistical analyses included principal component analysis (PCA), structural equation modeling (SEM), and moderated mediation analysis. Among participants, 79.3% reported experiencing or witnessing DCB. Psychological/social impact partially mediated the relationship between DCB and hospital management issues ( = 0.19, = 0.001). Response strategies reduced the psychological/social impact of DCB ( = -0.20, < 0.001) but did not mitigate its direct effect on hospital management. While prompt responses can alleviate the psychological burden on victims, they do not prevent broader institutional damage caused by DCB. Effective interventions should focus on both individual and organizational measures to reduce the occurrence of DCB.
破坏性行为（DCB）会损害医疗团队的沟通，从而对患者安全产生负面影响。在日本医院中，等级结构和传统领导风格导致了这种行为的持续存在。本研究调查了两家综合医院中DCB的发生率及其影响，并评估了应对策略在减轻其影响方面的作用。对两家综合医院（分别有751张床位和661张床位）的256名医护人员进行了基于网络的定量调查。调查内容包括人口统计学数据、经过验证的DCB量表，以及一份评估触发因素、应对措施和影响的结构化问卷。统计分析包括主成分分析（PCA）、结构方程模型（SEM）和调节中介分析。在参与者中，79.3%的人报告经历过或目睹过DCB。心理/社会影响部分介导了DCB与医院管理问题之间的关系（β = 0.19，p = 0.001）。应对策略降低了DCB的心理/社会影响（β = -0.20，p < 0.001），但并未减轻其对医院管理的直接影响。虽然及时的应对措施可以减轻受害者的心理负担，但并不能防止DCB对更广泛的机构造成损害。有效的干预措施应侧重于个人和组织层面，以减少DCB的发生。
