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Aggression at the Service Delivery Interface
Do you see what I see?
Loraleigh Keashly
Department of Communication, Wayne State University, Detroit MI, USA
Joel H Neuman
School of Business, State University of New York at New Paltz, New Paltz NY, USA
Abstract
Aggression at the service delivery interface (the point of contact between service provider and service recipient) has become a focus of much recent research attention. However, much of what we know is based on cross-sectional survey data - which tells us little about the underlying dynamics within specific aggressive incidents.
Further, these data are often collected from the perspective of the service provider alone. For this study, we focused on specific hostile interactions during the delivery of healthcare services and gathered data from the perspectives of service providers and service recipients. Drawing on interviews with US Department of Veterans Affairs (VA) staff and US military veterans, we categorised and compared each party’s attributions for the initiation of hostile (unpleasant) encounters.
We found that staff and veterans had different perspectives on the nature of precipitating factors and that the initial attribution for the event was linked to differences in subsequent responding. These findings are discussed in terms of their insight into the temporal dynamics of aggressive events and their implications for the prevention and management of hostility at the service delivery interface.
Keywords
workplace aggression, dynamics of aggression, management of aggression, conflict, patient–staff interactions, healthcare delivery
Article Text
Background
Workplace aggression and violence is a well documented problem in the health care sector. To give a sense of the extent of the problem of aggression at the staff-client interface, 44% of workers surveyed by Northwestern National Life Insurance (1993) reported being attacked and 36% reported being threatened by a client or customer. According to Kingma (2001), healthcare workers are 16 times more likely to experience violent assaults than any other service workers. In a review of violence in federal agencies based on 1993 Office of Workers Compensation Plan data, Freeman, Fox, Burr and Santasine (1996) found that the US Department of Veterans Affairs (VA) had one of the highest rates of fatal and nonfatal assaults of all federal agencies and that the targets tended to be nursing staff and police. Thus, what is clear is that the healthcare service delivery interface is a fertile one for hostile interactions. In addition, from a scientific perspective, the higher base rates of aggression in healthcare settings provide an opportunity to examine the dynamics of these incidents.
The delivery of healthcare services is characterised by a number of factors associated with the onset of aggression. For example, there is substantial literature linking aggression to perceptions of injustice and provocation (social), frustration and stress (situational) or factors that produce psychological (emotional) or physiological arousal/discomfort such as, heat, cold, poor lighting and/or air quality, crowding etc (Anderson, Anderson & Deuser 1996; Greenberg & Alge 1998). These variables are ubiquitous in VA (and other healthcare systems) in the form of long waits for service, delays in treatment, being in pain or discomfort, perceived intrusion into one’s personal life (and most private space) and uncomfortable physical environments associated with many older facilities or resulting from cost-control measures. These may all contribute to hostile responses from patients and their families (eg Hoad 1993). From the employee perspective, downsizing, restructuring, increasing workloads, unhappy clients and generally, having to do more with less has come to characterise the current healthcare system. This volatile mix produces an environment rife with antecedents strongly linked to interpersonal aggression in general and workplace aggression in particular (Baron & Neuman 1996).
Unfortunately, although much research has been done on the service delivery interface in healthcare, it has been limited almost exclusively to data collected from the service provider’s perspective – viewing the service recipient (ie patient/client) as the source of the problem. Common sense and a good deal of research on interpersonal conflict and aggression, suggests that this assumption is misguided.
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