Hospital researchers propose using safety reports to track workplace run-ins

While designed to flag threats to patient safety, hospitals’ incident reporting systems can do double duty as monitors of conflicts between healthcare workers, according to a study published online Feb. 6 in PLoS One. The finding may be of interest to radiology departments, as imaging procedures were among the most common sources of such conflicts in the study.

Jih-Shuin Jerng, MD, and colleagues at the 2,300-bed National Taiwan University Hospital in Taipei retrospectively reviewed reports filed to their institution’s incident reporting system over a three-year period.

Along with structured checkboxes to report safety concerns, the system offers users access to a free-text field.

The authors identified 147 safety incidents that had free-text comments on workplace interpersonal conflict.

Of these, they found upon analysis, the most common related processes were patient transfer (20 percent), lab tests (17 percent), surgery (16 percent) and medical imaging (16 percent).

All 147 incidents with interpersonal conflict between workers focused on task content or task process, while 41 (27.9 percent) also mentioned the interpersonal relationship.

The team found disagreement in 91.2 percent of the cases, followed by interference (88.4 percent) and negative emotion (55.8 percent).

Also:

• Nurses (57 percent) were most often the reporting workers, while the most common encounter was the nurse-doctor interaction (33 percent), and the majority (67 percent) of the conflicts were experienced concurrently with the incidents.
• There was a significant difference in the distribution of worker job types between cases focused on the interpersonal relationship and those without (p = 0.0064).
• Physicians were more frequently identified as the reporters when the conflicts focused on the interpersonal relationship (34.1 percent) than not on it (17 percent).

In their discussion, the authors suggest the use of incident reporting systems as a channel for reporting interpersonal conflict could offer hospitals a means of improving workplace safety and job satisfaction across the institution.

“Traditionally, interpersonal conflicts among nurses were called ‘horizontal violence.’ However, we found a substantial number of workplace interpersonal conflicts focusing on interpersonal relationship across different disciplines and units,” Jerng et al. write.

Management of the reported events in incident reporting systems is “mainly task-oriented [and] therefore might reduce the tension between the workers with interpersonal conflicts and focus more on the goal of the task and the expected provided care,” they add. “[H]ealthcare systems need to improve the channels to communicate, manage and resolve interpersonal conflicts.”

The study report is available in full for free.