Disruptive behavior in a high-power distance culture and a three-dimensional framework for curbing it

Understanding Emotional Intelligence to Enhance Leadership and Individualized Well-Being

The successful team concept extends beyond the operating room and into many areas of hand surgery practice. Effective leadership is critical in creating highly effective teams. Evidence suggests that leadership skills can be learned and developed. The authors synthesize and translate findings from organizational psychology to provide insight and recommendations for clinical practice. Specifically, the role of broad emotional intelligence in leadership is explored. This includes self-awareness (eg, understanding one's strengths, challenges, behavioral tendencies, and emotional reactions), emotion regulation, managing others' emotions (eg, supporting others' needs, managing interpersonal conflict, and displaying empathy), and high-quality communication and establishing/maintaining boundaries.

The Relationship between Negative Leadership Behaviours and Silence among Nurses

Background: Negative leadership behaviour is very common and pervasive in nursing and healthcare, often leading to adverse effects such as nurses' silence, decreased job performance, and turnover. However, there is a lack of systematic reviews that summarize negative leadership types and nurses silencing behaviours. Aim: This systematic review examined the relationship between negative leadership behaviour and nurses' silence. Evaluation: We searched PubMed, Embase, the Cochrane Library, Web of Science, CNKI, VIP, and Wanfang databases from their inception until 30 April 2024 for articles examining the relationship between negative leadership and silent behaviour among nurses. The studies were reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias in the included studies was assessed using the Newcastle-Ottawa Scale. Key Issues: After full-text analysis, six papers were included in this systematic review. Four of the studies were conducted with nurses, and the remaining two were conducted with all medical staff including nurses. While most studies have shown that negative leadership causes nurses to become increasingly silent, others have shown that appropriate negative leadership behaviour instead reduces nurses' silence. Conclusions: Negative leadership behaviour can affect the silent behaviour of nurses. Implications for Nursing Management: Hospitals need to take the initiative to build a harmonious and safe working environment, correctly recognize and identify negative management behaviour, take appropriate and effective measures to enhance the positive leadership of nurse managers, and make an effort to prevent nursing staff's exposure to the negative management of direct leadership and mental health threats, which is a key point that hospital administrators and health policymakers tend to overlook. This is also effective for enhancing the leadership of hospital administrators.

Issues and Perspectives for the Study of Disruptive Clinician Behavior

This article discusses issues and perspectives related to the study of disruptive clinician behavior (DCB) to improve patient safety and healthcare professionals' work environments. Multiple terminologies and ambiguous definitions have resulted in conceptual confusion in studies on DCB. In addition, subjective classifications have led the attributes of DCB to overlap and fluctuate. Therefore, we share Rosenberg's definition of DCB as "any inappropriate behavior, confrontation, or conflict, ranging from verbal abuse to physical and sexual harassment." It is recommended that DCB be understood as a hierarchical structure identified through statistical analysis of field survey data. Furthermore, a recurring list of items is duplicated across existing studies on DCB triggers, contributing factors, and influences. These items can be organized into separate path models based on their mutual relationships. Given these assumed models, we believe that further studies on DCB can shift toward elucidating the mechanisms of occurrence and impact. Finally, based on the path models, we recommend improving healthcare professionals' psychological and social states through a policy shift from "zero-tolerance" to "to err is human" as a priority issue for DCB prevention and countermeasures.

The prevalence of incivility in hospitals and the effects of incivility on patient safety culture and outcomes: A systematic review and meta-analysis

AIM

Workplace incivility is a barrier to safe and high-quality patient care in nursing workplaces and more broadly in tertiary hospitals. The present study aims to systematically review the existing evidence to provide a comprehensive understanding of the prevalence of co-worker incivility experienced and witnessed by nurses and other healthcare professionals, the effects of incivility on patient safety culture (PSC) and patient outcomes, and the factors which mediate the relationship between incivility and patient safety.

METHODS

A systematic review with narrative synthesis and meta-analysis was undertaken to synthesize the data from 41 studies.

DATA SOURCES

Databases searched included MEDLINE, PubMed, SCOPUS, CINAHL, PsycInfo, ProQuest, Emcare and Embase. Searches were conducted on 17 August 2021 and repeated on 15 March 2023.

RESULTS

The pooled prevalence of experienced incivility was 25.0%. The pooled prevalence of witnessed incivility was 30.1%. Workplace incivility was negatively associated with the PSC domains of teamwork, reporting patient safety events, organization learning/improvement, management support for safety, leadership, communication openness and communication about error. The composite pooled effect size of incivility on these domains of PSC was OR = 0.590, 95% CI [0.515, 0.676]. Workplace incivility was associated with a range of patient safety outcomes (PSOs) including near misses, adverse events, reduced procedural and diagnostic performance, medical error and mortality. State depletion, profession, psychological responses to incivility, information sharing, help seeking, workload and satisfaction with organizational communication were found to mediate the relationship between incivility and patient safety.

CONCLUSION

Experienced and witnessed incivility is prevalent in tertiary hospitals and has a deleterious effect on PSC and PSOs. A better understanding of the mechanisms of this relationship will support the development of interventions aimed at reducing both incivility and patient harm.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE IMPACT

This study quantifies the effect of incivility on PSC and outcomes. It provides support that interventions focusing on incivility are a valuable mechanism for improving patient care. It guides intervention design by highlighting which domains of PSC are most associated with incivility. It explores the profession-specific experiences of workplace incivility.

REPORTING METHOD

This report adheres to PRISMA reporting guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution. The focus of this study is the nursing and healthcare workforce, therefore, patient or public involvement not required.

Disruptive Behavior and Factors Associated with Patient Safety Climate: A Cross-Sectional Study of Nurses' and Physicians' Perceptions

Background

Few studies have analyzed the negative outcomes of disruptive behaviors in the nurse-physician relationship in patient care and their impact on patient safety. These multicausal studies significantly relate to organizational, institutional, and professional attitudinal risk factors.

Aim

Analyze healthcare professionals' perceptions of disruptive behavior and factors associated with patient safety climate in the nurse-physician relationship at the hospital level.

Methods

A multicenter cross-sectional study was conducted with a sample of 370 nurses and physicians assigned to different public hospitals in the Murcia/Spain region, applying the adapted and validated Spanish version of the Nurse-Physician Relationship Scale: Impact of Disruptive Behavior on Patient Care. The analysis used proportions or means (standard deviation (SD)), univariate and multivariate linear regression models, and the chi-square test.

Results

Disruptive behavior was more prevalent in the ICU (81.6%) and the emergency department (67.8%). Professionals indicate that fear of reprisals is the main barrier to the reporting system. Likewise, stress and frustration are more associated with disruptive behavior and influence the safety climate.

Conclusion

Professionals indicate that disruptive behaviors can have a negative impact on clinical outcomes. Age and type of service were identified as the most relevant socio-occupational factors. Stress, frustration, and communication problems are the factors that most influence the safety climate.

Kindness Isn't Just about Being Nice: The Value Proposition of Kindness as Viewed through the Lens of Incivility in the Healthcare Workplace

The healthcare workplace is a high-stress environment. All stakeholders, including patients and providers, display evidence of that stress. High stress has several effects. Even acutely, stress can negatively affect cognitive function, worsening diagnostic acumen, decision-making, and problem-solving. It decreases helpfulness. As stress increases, it can progress to burnout and more severe mental health consequences, including depression and suicide. One of the consequences (and causes) of stress is incivility. Both patients and staff can manifest these unkind behaviors, which in turn have been shown to cause medical errors. The human cost of errors is enormous, reflected in thousands of lives impacted every year. The economic cost is also enormous, costing at least several billion dollars annually. The warrant for promoting kindness, therefore, is enormous. Kindness creates positive interpersonal connections, which, in turn, buffers stress and fosters resilience. Kindness, therefore, is not just a nice thing to do: it is critically important in the workplace. Ways to promote kindness, including leadership modeling positive behaviors as well as the deterrence of negative behaviors, are essential. A new approach using kindness media is described. It uplifts patients and staff, decreases irritation and stress, and increases happiness, calmness, and feeling connected to others.

Authentic Leadership and Psychological Well-Being of Nurses: A Mediated Moderation Model

Aims

This study investigates how authentic leadership influences the psychological well-being of Australian nurses. We examined whether authentic leadership could reduce the prevalence of workplace incivility and tested whether shared values and person-organization (P-O) fit could moderate the relationship between workplace incivility and psychological well-being (PWB). A mediated moderation model underpinned by social learning theory was developed to test the influence of authentic leadership on PWB.

Design

We adopted a descriptive correlational research design to test the hypothesized model with a cross-sectional sample of Australian nurses using an online survey. Data were collected across two-waves separated by a six-month interval (N = 230, response rate = 38.3%) to minimize the potential effects of common source bias. The hypotheses were tested using Hayes Process Macro (Model 14) on IBM SPSS.

Results

The hypothesized model had good fit indices and supported the mediated moderation model. There was no support for the direct association between authentic leadership and PWB. The supervisor authentic leadership behavior was negatively associated with workplace incivility and PWB. The association between incivility and PWB was positively associated with P-O fit. Nurses with high P-O fit reacted strongly to the positive effect of authentic leadership in reducing workplace incivility, such that they experienced higher levels of PWB.

Conclusion

Authentic leadership behavior is important in the healthcare workplace. It reduces workplace incivility and improves PWB for nurses with high levels of congruence. Implications: our study suggests that senior management should deploy strategies through which frontline supervisors can learn and enact authentic leadership behaviors. They will then be better equipped to improve the PWB of their followers by minimizing the prevalence of workplace incivility. Impact: the study found a significant indirect relationship between authentic leadership behavior and psychological well-being, as mediated by workplace incivility and moderated by person-organization fit. The findings highlight the importance of positive leadership behaviors on the well-being outcomes of nurses in Australia.