Development of a Psychological Scale for Measuring Disruptive Clinician Behavior

Abstract

Objectives Disruptive clinician behavior worsens communication, information transfer, and teamwork, all of which negatively affect patient safety. Improving safety in medical care requires an accurate assessment of the damage caused by disruptive clinician behavior. Psychometric scales complement case reports, but existing scales have significant limitations. Therefore, this study developed a psychometric scale based on the psychological paradigm to assess disruptive clinician behavior. Methods The scale was developed through a sequence of steps. First, we used an open-ended questionnaire targeting 712 nurses, content analysis, and content validity assessment by 5 experts to determine valid items for disruptive clinical behavior. Next, an Internet questionnaire survey targeting 1000 health care staff, exploratory factor analysis, and subfactor analysis was conducted to identify necessary and sufficient factors. Then, we calculated difficulty level and discriminative power. We also conducted a field questionnaire survey targeting 84 staff in a hospital. Finally, we calculated ω coefficients and then used confirmatory factor analysis to verify the fit of the hypothesized model. Results Our open-ended survey involving 478 nurses identified 47 codes in 9 categories. The questionnaire survey involving hospital 1000 medical staff identified 6 factors, with 1 factor subdivided into 4 subfactors and 1 into 2 subfactors. The goodness of fit of the hypothesized 10-factor models with factor pairs and groups was confirmed. Conclusions We developed a psychometric scale measuring subjective assessments of harm covering various disruptive clinician behaviors. The scale complements interviews and case reports by generating valid, reliable scores for various disruptive clinician behaviors in health care institutions.

Issues and Perspectives for the Study of Disruptive Clinician Behavior

“…Through a confirmatory factor analysis, a one-factor structural model was created, in which three pairs were categorized as “bullying others-humiliation of others,” “turned back-hung up phone,” and “discriminatory comments-physical aggression.” Fujimoto et al also conducted an open-ended questionnaire along with two questionnaires on medical staff members’ perceptions of DCB. Their analysis, based on a scale construction process, identified the hierarchical categories of DCB [ 32 ]. This hierarchical model (Table 1 ) comprised categories also identified in many subjective studies.…”

“…Interpersonal aggression involves “psychological aggression,” “incivility,” “ignoring,” and “physical violence.” Psychological aggression is further divided into “intimidation,” “reproof,” “threats,” and “abusive language.” The 10 identified DCB types roughly corresponded one-to-one or across several types with the category system established by Petrovic et al [ 14 ]. However, the category systems established by Petrovic et al [ 14 ] and Fujimoto et al [ 32 ] have two differences. The first is discrimination.…”

“…The first is discrimination. In the classification used by Fujimoto et al [ 32 ], discrimination is an item that constitutes abusive language, whereas Petrovic et al [ 14 ] consider it an independent category. This may be because discrimination against racial, ethnic, religious, and other minorities occurs more frequently in the West, where diversity is higher than in Japan [ 36 ].…”

“…However, power and sexual harassment, for example, are essentially different behaviors in terms of their cause, conduct, and impact. The classification by Fujimoto et al [ 32 ] leaves no room for the classifier’s subjectivity or commonality of language in the classification criteria. Therefore, in their classification, power harassment refers to a pair of behaviors: mismanagement practices and reproofing.…”

“…The manifestation of DCB is a factor that separates the direct and indirect impact paths. Explicit DCB increases the risk to patient safety, whereas spiteful DCB exacerbates the psychological and social adaptation of victims [ 32 ]. In addition, DCB both directly and indirectly threatens patient safety and hospital management.…”