Date of Award

12-2011

Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Public Policy

First Advisor

David E. Matz

Second Advisor

Eben Weitzman

Third Advisor

Shifra Shvarts

Abstract

Disruptive behaviors among hospital staff negatively affect quality of care. Motivated by The Joint Commission new standard on disruptive behavior, and by aspiration to improve patient care, minimize liability and attract and retain staff, hospitals are setting policies to prevent or resolve conflicts. However, it is unknown whether a uniform set of conflict management tools is equally effective among different hospital departments. To address this question we identified similarities and differences among hospital departments in the antecedence, characteristics and outcomes of disruptive behaviors and in the effectiveness of conflict management tools. We concentrated on conflicts between residents and nurses in time-critical healthcare settings. The research included a comparison of the same group of residents providing services to two different departments in Sorokah hospital, using focus group discussions and interviews with residents, nurses and other key stakeholders. We further used a quantitative questionnaire-based assessment in eight departments at Rambam hospital. Almost all participants (89%) reported witnessing disruptive behavior, with intense work, miscommunication and personality of disputants being the most significant cause. The forms and antecedents of these behaviors, however, varied significantly between departments, with some departments more prone to express conflicts, while others were characterized by hidden disruptive behaviors. Whether hidden or expressed, disruptive behaviors negatively affect patient care and staff morale, with these outcomes influenced by the antecedents of behaviors. Importantly, antecedents of disruptive behaviors were also found to influence the effectiveness of alleviating tools. Some tools, such as processes for evaluating staff complaints, courses on teamwork and conflict management, and introducing of a mission statement on respectful behaviors, are effective for a range of antecedents. Other tools, on the other hand, are effective only for specific antecedents. These antecedent-specific tools fall into two principal categories: tools that directly remove a specific problem or tools that do not solve the problem, but offer a way to circumvent it. Our research identified how conflict nature and antecedents differ among hospital departments and point to differential effectiveness of implemented tools thereby facilitating a paradigm shift from a "one-size-fits-all" approach to a more effective "tailored" set of condition-specific conflict resolution tools.

Comments

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