A number of studies have identified disruptive behaviors by health care professionals as a significant factor in nurse job satisfaction and retention and patient safety (Kriteck, 2012). In their Sentinel Event #40, The Joint Commission defines “disruptive behaviors” as any “overt or passive behavior” that “undermines team effectiveness…” (Joint Commission, 2008). Examples of disruptive behavior given in the alert include, “verbal outbursts or physical threats… condescending language or voice intonation… impatience with questions… reluctance or refusal to answer questions, return phone calls or pages… refusing to perform assigned tasks or quietly exhibiting uncooperative attitudes during routine activities” (Joint Commission, 2008).
An original study by Rosenstein and O’Daniel found that patterns of disruptive behavior, defined as “any inappropriate behavior, confrontation, or conflict ranging from verbal abuse to physical and sexual harassment,” occur in two directions of the power structure, both laterally and horizontally (Rosenstien & O'Daniel, 2005, p. 2). The Center for American Nurses defines horizontal violence as ““the physical, verbal or emotional abuse of an employee, associated with a perpetrator at a higher level or authority gradient” and while their definition of lateral violence is specifically defined as, “nurse to nurse aggression” (Center for American Nurses, 2008).
These behaviors can have negative consequences, such as adverse patient outcomes, malpractice threats and loss of retention (Rosenstien & O'Daniel, 2005). The purpose of this research project is to identify and compare conflicts and collaborations that occur across two different types of healthcare organizations (transaction-based and patient-centered), analyze how they affect the workplace environment and quality of care, and determine how conflict resolution applications can best support optimal outcomes and environments for patients and providers alike.
The transaction-based system, or fee-for-service model (FFS), traditionally generates revenue based on the production of services, rather than medical outcomes, and functions as an array of individual health care professionals and specialists from which a patient can choose her or his provider at any given time, according to insurance company policies and individual benefits (Enthoven, 2009).
Over the past decade reformed models of health care have evolved, known as patient-centered medical homes, which function on principles of shared responsibility for patients, bundled fees for services, and coordination of information between providers and patients to help control the rising costs of health care (pcpcc.net).
By comparing the occurrences of conflicts and collaborations between health care professionals from both of these types of settings, this study may serve as an assessment tool for evaluating the effectiveness of conflict prevention and intervention strategies in participating organizations.