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In response to the growing evidence that disruptive behaviors within health care teams constitute a major threat to the quality of care, the Joint Commission on Accreditation of Healthcare Organization (JCAHO; Joint Commission Resources, 2008) has a new leadership standard that addresses disruptive and inappropriate behaviors effective January 1, 2009. For professionals who work in human resources and organization development, these standards represent a clarion call to design and implement evidence-based interventions to create health care communities of respectful engagement that have zero tolerance for disruptive, uncivil, and intimidating behaviors by any professional. In this chapter, we will build an evidence-based argument that sustainable change must include organizational, team, and individual strategies across all professionals in the organization. We will then describe an intervention model – Toxic Organization Change System – that has emerged from our own research on toxic behaviors in the workplace (Kusy & Holloway, 2009) and provide examples of specific strategies that we have used to prevent and ameliorate toxic cultures.

Incivility is widespread in the workplace and has been shown to have significant affective and behavioral consequences. However, the authors still have a limited understanding as to whether, how and when discrete incivility events impact team performance. Adopting a resource depletion perspective and focusing on the cognitive implications of such events, the authors introduce a multi-level model linking the adverse effects of such events on team members’ working memory – the “workbench” of the cognitive system where most planning, analyses, and management of goals occur – to team effectiveness. The model which the authors develop proposes that that uncivil interpersonal behavior in general, and rudeness – a central manifestation of incivility – in particular, may place a significant drain on individuals’ working memory capacity, affecting team effectiveness via its effects on individual performance and coordination-related team emergent states and action-phase processes. In the context of this model, the authors offer an overarching framework for making sense of disparate findings regarding how, why and when incivility affects performance outcomes at multiple levels. More specifically, the authors use this framework to: (a) suggest how individual-level cognitive impairment and weakened coordinative team processes may mediate these incivility-based effects, and (b) explain how event, context, and individual difference factors moderators may attenuate or exacerbate these cognition-mediated effects.

In the USA, there has recently been an unprecedented convergence of complementary/alternative medicine (CAM) with mainstream biomedical care. This confluence may lead to a deeply rooted philosophical conflict. This qualitative study works to identify factors that health-care leaders can use, which will build a pathway to greater integrative practice between medical doctors and CAM practitioners – from parallel existence to partnership – by examining the tensions between biomedical medicine and naturopathic medicine. The purpose of this study is to offer short-term suggestions for partnership and long-term recommendations for better understanding.

An original qualitative study using semi-structured with CAM practitioners and biomedical practitioners.

Areas of conflict that are preventing synergy are identified and a pathway for health-care leaders to follow to create greater integration and partnerships is suggested.

This is a qualitative and exploratory study that has significant limitations on generalizability.

This study suggest steps that both types of health-care practitioners can take to increase their success at working together on an individual level, a group level, an organizational level and on an industry-wide basis, as well as provide a specific pathway to create greater integrative practice for health-care leaders.

The results indicate that stronger partnerships between different types of medical practitioners increase patient choice, patient satisfaction and outcomes.

Increasing interested in CAM modalities is driving more contact between CAM practitioners and biomedical practitioners. This contact is best established in partnership between practitioners rather than in parallel. This original research outlines the sources of conflict and provides recommendations for encouraging greater synergy.

The purpose of this study is to empirically test a hierarchical model of the antecedents of nurse job satisfaction and loyalty based on the internal marketing literature. Specifically, the study aims to investigate the degree to which structural, social, and financial bonding activities influence nurses' job satisfaction and retention.

Following a review of the literature, the model was tested via a survey of 200 nurses from three US health care institutions.

The study resulted in key findings pertaining to the hierarchical nature of structural, social, and financial bonding activities and their impact on job satisfaction and loyalty.

Service industries that depend on front‐line employees to deliver high quality services are provided with innovative suggestions to improve job satisfaction and loyalty of their employees by employing an internal marketing approach. The study provides organizations with empirical evidence regarding the synergistic effects of bonding activities.

To the best of the authors' knowledge, this is the first time a hierarchical/sequential model of the impact that relationship bonds have on satisfaction and retention of health care staff has been empirically tested. The findings that structural bonds have both a direct and indirect impact on job satisfaction and loyalty are of value for interested academics working in this area and are relevant for companies trying to improve job satisfaction and loyalty of their employees.

The simulation of fracture processes for discrete crack propagation is well established for linear‐elastic cracking problems. Applying finite element techniques for the numerical formulation, at every incremental macro‐crack step the element mesh has to be adapted such that the crack path remains independent of the initial mesh. The accuracy of the obtained results has to be controlled by suitable error estimators and error indicators. Considering the dependence of the predicted crack path on the precision of the displacement and stress computation, quality measures for the computed results are recommended. In this research the use of the Babuska/Rheinboldt error indicator in combination with linear‐elastic crack propagation problems is demonstrated. Based on this error measure an adaptive mesh refinement technique is developed. In comparison with classical discrete crack propagation simulations the advantages of the new concept can be clearly observed.

This study aims to reconcile some of the conflicting results in prior studies of the board structure–firm performance relationship and to evaluate the effectiveness and applicability of agency theory in the specific context of Italian corporate governance practice.

This research applies a dynamic generalised method of moments on a sample of Italian listed companies over the period 2003-2015. Proxies for corporate governance mechanisms are the board size, the level of board independence, ownership structure, shareholder agreements and CEO–chairman leadership.

While directors elected by minority shareholders are not able to impact performance, independent directors do have a non-linear effect on performance. Board size has a positive effect on firm performance for lower levels of board size. Ownership structure per se and shareholder agreements do not affect firm performance.

This paper contributes to the literature on agency theory by reconciling some of the conflicting results inherent in the board structure–performance relationship. Firm performance is not necessarily improved by having a high number of independent directors on the board. Ownership structure and composition do not affect firm performance; therefore, greater monitoring provided by concentrated ownership does not necessarily lead to stronger firm performance.

This paper suggests that Italian corporate governance law should improve the rules and effectiveness of minority directors by analysing whether they are able to impede the main shareholders to expropriate private benefits on the expenses of the minority. The legislator should not impose any restrictive regulations with regard to CEO duality, as the influence of CEO duality on performance may vary with respect to the unique characteristics of each company.

The results enrich the understanding of the applicability of agency theory in listed companies, especially in Italy. Additionally, this paper provides a comprehensive synthesis of research evidence of agency theory studies.

Previous research has demonstrated that communication failure and interpersonal conflicts are significant impediments among health care teams to assess complex information and engage in the meaningful collaboration necessary for optimizing patient care. Despite the prolific research on the role of effective teamwork in accomplishing complex tasks, such findings have been traditionally applied to business organizations and not medical contexts. This chapter, therefore, reviews and applies four theories from the fields of organizational behavior (OB) and organization development (OD) as potential means for improving team interaction in health care contexts. This study is unique in its approach as it addresses the long-standing problems that exist in team communication and cooperation in health care teams by applying well-established theories from the organizational literature. The utilization and application of the theoretical constructs discussed in this work offer valuable means by which the efficacy of team work can be greatly improved in health care organizations.

The purpose of this paper is to explore the relationship of horizontal violence, organizational cynicism and turnover intention in the nursing profession.

A quantitative approach was utilized and 870 questionnaires were distributed to collect data from nursing staff working in Punjab region of Pakistan by using non-probability multistage sampling technique. A total of 711 questionnaires were returned, out of which, 668 questionnaires were scrutinized. Additionally, confirmatory factor analysis and structural equation modeling were applied to analyze the data.

The results revealed an insignificant mediating effect of organizational cynicism between the relationship of horizontal violence and turnover intention.

The current study has adopted a multistage non-probability sampling technique to collect data because the management of hospitals restricted researcher access to personal information about the nurses. Therefore, at the first stage, the researcher used convenience sampling and at the second stage, the researcher utilized quota sampling to collect the data. Moreover, the findings of the current study are based on cross-sectional data because of the limited time and resources.

The current study fosters the ongoing debate in organizational studies related to cynicism, and it is noteworthy for the nursing managers to understand the significant factors which directly or indirectly affect the nursing attitude.

The current study explored the mediating role of organizational cynicism between horizontal violence and turnover intention to fill the research gap.

The Institute of Medicine (IOM) views Health Information Technology (HIT) as an essential organizational prerequisite for the delivery of safe, reliable, and cost-effective health services. However, HIT presents the proverbial double-edged sword in generating solutions to improve system performance while facilitating the genesis of novel iatrogenic problems. Incongruent organizational processes give rise to technological iatrogenesis or the unintended consequences to system integrity and the resulting organizational outcomes potentiated by incongruent organizational–technological interfaces. HIT is a disruptive innovation for health services organizations but remains an overlooked organizational development (OD) concern.

Recognizing the technology–organizational misalignments that result from HIT adoption is important for leaders seeking to eliminate sources of system instability. The Health Information Technology Iatrogenesis Model (HITIM) provides leaders with a conceptual framework from which to consider HIT as an instrument for organizational development. Complexity and Diffusion of Innovation theories support the framework that suggests each HIT adoption functions as a technological change agent. As such, leaders need to provide operational oversight to managers undertaking system change via HIT implementation. Traditional risk management tools, such as Failure Mode Effect Analysis and Root Cause Analysis, provide proactive pre- and post-implementation appraisals to verify system stability and to enhance system reliability. Reconsidering the use of these tools within the context of a new framework offers leaders guidance when adopting HIT to achieve performance improvement and better outcomes.

Hospitals must systematically support employees in innovative ways to uphold a culture of care that strengthens the system. At a leading Canadian academic pediatric rehabilitation hospital, over 90 percent of clinicians viewed Schwartz Rounds™ (SR) as a hospital priority, resulting in its formal implementation as a quality improvement initiative. The purpose of this paper is to describe how the hospital implemented SR to support the socio-emotional impact of providing care.

This quantitative descriptive study provides a snapshot of the impact of each SR through online surveys at four assessment points (SR1-SR4). A total of 571 responses were collected.

All four SR addressed needs of staff as 92.9-97.6 percent of attendees reported it had a positive impact, and 96.4-100 percent of attendees reported each SR was relevant. Attendees reported significantly greater communication with co-workers after each SR (p<0.001) and more personal conversations with supervisors after SR2 and SR4 (p<0.05) compared to non-attendees. Attending SR also increased their perspective-taking capacity across the four SR.

As evidenced in this quality improvement initiative, SR addresses staff’s need for time to process the socio-emotional impacts of care and to help reduce those at risk for compassion fatigue. SR supports and manages the emotional healthcare culture, which has important implications for quality patient care.

This research details an organization’s process to implement SR and highlights the importance of taking care of the care provider.