{"id":"4019ea60-36af-45d6-9aa5-a04ea8164595","slug":"analysis-of-inter-provider-conflicts-among-healthcare-providers","title":"Analysis of inter-provider conflicts among healthcare providers","authors":["Mona Stecker","Nancy Epstein","Mark M. Stecker"],"abstract":"Background: Patient safety is a top priority of healthcare organizations. The Joint Commission (TJC) is now requiring that healthcare organizations promulgate polices to investigate and resolve disruptive behavior among employees. Methods: Our aims in this investigation utilizing the Provider Conflict Questionnaire (PCQ: Appendix A) included; determining what conflicts exist among a large sample of healthcare providers, how to assess the extent and frequency of disruptive behaviors, and what types of consequences result from these conflicts. The PCQ was distributed utilizing electronic postings, and predetermined e-mail lists to nurses and physicians across the US. Results: The convenience sample included 617 respondents to the questionnaire. All incomplete responses (failure to answer all 17 items on the questionnaire) were excluded from data analysis. Our major finding was that disruptive behavior was the greatest problem observed in 82% of organizations; 74% personally witnessed these behaviors, while 5% personally experienced these behaviors. Friedman analysis of variance (ANOVA) analyses demonstrated that the difference between these three estimates were significant (χ2 = 207.8 df = 2, P < 0.0001). Conclusion: Healthcare organizations in the US are bound by TJC regulations to develop leadership standards that address disruptive behavior. These organizations can no longer stand by and ignore behaviors that threaten not only the bottom line of the institution, but also most critically, patient safety. As more attention is being paid to recommendations and mandates from the TJC and the Institute of Medicine (IOM), we will need more data, like those provided from this study, to better document how to address, resolve, and prevent future “misbehaviors”. Few would deny that disruptive behaviors exist in hospital settings, and that there is a need to minimize them. However, relatively little is known about the nature and frequency of such behaviors occurring between medical care providers. This article is an attempt to better understand the problem. Utilizing the Provider Conflict Questionnaire (PCQ), the article attempts to document the extent to which disruptive behaviors occur, and delineates to some extent, the “who, what, and where” of the problem. A major shortcoming of the study is that 88% of the 617 respondents were nurses. The findings, therefore, largely reflected their opinions and biases. However, interestingly, there were no significant differences in the rates of organizational, witnessed, and personal experiences of disruptive behaviors by gender. As the nurses were predominantly female, and the nonnurses (doctors and administrators) were predominantly male, this suggests that the results may have not been substantially different had the population included more doctors. In any case, a follow-up study should include a larger sample of doctors. This is particularly important as nurses (predominantly females and including female Physician Assistants and Nurse Practitioners) and doctors (predominantly males) agreed that physicians were most often responsible for the disruptive behaviors. This is not to say that everyone involved cannot be better behaved. Furthermore it is easy to find shortcomings in social scientific studies of complex situations, including this one. This study was not a randomized, controlled study, and the questionnaire data were largely based upon qualitative and impressionistic responses. But scientific inquiry starts with descriptive studies, and if we are going to make progress here, we have to move from complaints in the hallway to more rigorous documentation and description. We should, therefore, use this opportunity to improve the social environment in our hospitals, especially given that some claim that disruptive behavior negatively impacts patient care. Interestingly, it appears that the mere existence of appropriate institutional policies and procedures aimed at addressing disruptive behaviors decreased the incidence of these behaviors. Let's hope that articles like this will initiate discussions in institutions that do not have these policies, and will help improve the policies in those institutions that do.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/4019ea60-36af-45d6-9aa5-a04ea8164595/featured/hero-1782420788077.png","publishDate":"2013-10-29T00:00:00.000Z","doi":"10.4103/2152-7806.120781","categories":["Original Article"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/4019ea60-36af-45d6-9aa5-a04ea8164595/pdf"}