To read this content please select one of the options below:

Antecedents of customer aggressive behavior against healthcare employees

Amit Gur (Department of Health Systems Management, The Max Stern Yezreel Valley College, Yezreel, Israel)
Shay S. Tzafrir (Department of Business Administration, University of Haifa, Haifa, Israel)
Christopher D. Zatzick (Beedie School of Business, Simon Fraser University, Burnaby, Canada)
Simon L. Dolan (ESADE-Ramon Llull University, Barcelona, Spain)
Roderick Iverson (Beedie School of Business, Simon Fraser University, Vancouver, Canada)

Management Research

ISSN: 1536-5433

Article publication date: 19 June 2017




The purpose of the research was to develop a tool for measuring antecedents of customer aggressive behavior (CAB) in healthcare service settings, by identifying its roots in organizational and interpersonal dynamics.


Four studies were conducted. In Studies 1 and 2, antecedents of CAB were identified through analysis of internet reader comments and a questionnaire was distributed to students. In Study 3, scenarios were used to validate the findings of the previous studies. Finally, in Study 4, a scale was developed and validated for measuring organization- and person-related triggers of CAB using samples of 477 employees and 579 customers.


The concept of CAB was conceptualized and validated. In total, 18 items were identified across five dimensions: personal characteristics, uncomfortable environment, aggressive role models, reinforcement of aggressive behavior and aversive treatment. The scale demonstrated good psychometric results.

Research limitations/implications

The research relies mainly on customer perspective. Employees and additional stakeholders should be included to achieve more accurate information that could contribute to a better understanding of CAB and its roots.

Practical implications

Exploring social and organizational antecedents that trigger CAB could help healthcare managers evaluate and proactively manage CAB and its implications within their organization.


This measurement scale is the first comprehensive tool, based on Bandura’s social learning theory (1973), that may identify and measure antecedents of CAB, and could be used to reduce CAB in healthcare service settings.



Roderick Iverson is now deceased.


Gur, A., Tzafrir, S.S., Zatzick, C.D., L. Dolan, S. and Iverson, R. (2017), "Antecedents of customer aggressive behavior against healthcare employees", Management Research, Vol. 15 No. 2, pp. 207-226.



Emerald Publishing Limited

Copyright © 2017, Emerald Publishing Limited

Related articles