Workplace interpersonal conflicts among healthcare workers: Retrospective exploration from the institutional incident reporting system of a university-affiliated medical center
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This research article explores workplace interpersonal conflicts among healthcare workers and proposes that the incident reporting system might provide a channel to explore these conflicts. The article provides a retrospective review of reports to the IRS from July 2010 to June 2013 in a medical center. The article also provides data on the types of conflicts, the focus of the conflicts, and the properties of the conflicts.
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RESEARCH ARTICLE
Workplace interpersonal conflicts among the
healthcare workers: Retrospective exploration
from the institutional incident reporting
system of a university-affiliated medical
center
Jih-Shuin Jerng1,2, Szu-Fen Huang1,3, Huey-Wen Liang1,4, Li-Chin Chen1, Chia-Kuei Lin1,
Hsiao-Fang Huang1, Ming-Yuan Hsieh1, Jui-Sheng Sun1,5*
1 Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan, 2 Department of
Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, 3 Department of Nursing, National
Taiwan University Hospital, Taipei, Taiwan, 4 Department of Physical Medicine & Rehabilitation, National
Taiwan University Hospital, Taipei, Taiwan, 5 Department of Orthopedic Surgery, National Taiwan University
Hospital, Taipei, Taiwan
* drjssun@ntuh.gov.tw
Abstract
Objective
There have been concerns about the workplace interpersonal conflict (WIC) among health-
care workers. As healthcare organizations have applied the incident reporting system (IRS)
widely for safety-related incidents, we proposed that this system might provide a channel to
explore the WICs.
Methods
We retrospectively reviewed the reports to the IRS from July 2010 to June 2013 in a medical
center. We identified the WICs and typed these conflicts according to the two foci (task con-
tent/process and interpersonal relationship) and the three properties (disagreement, inter-
ference, and negative emotion), and analyzed relevant data.
Results
Of the 147 incidents with WIC, the most common related processes were patient transfer
(20%), laboratory tests (17%), surgery (16%) and medical imaging (16%). All of the 147 inci-
dents with WIC focused on task content or task process, but 41 (27.9%) also focused on the
interpersonal relationship. We found disagreement, interference, and negative emotion in
91.2%, 88.4%, and 55.8% of the cases, respectively. Nurses (57%) were most often the
reporting workers, while the most common encounter was the nurse-doctor interaction
(33%), and the majority (67%) of the conflicts were experienced concurrently with the inci-
dents. 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). The doctors
PLOS ONE | DOI:10.1371/journal.pone.0171696 February 6, 2017 1 / 13
a1111111111
a1111111111
a1111111111
a1111111111
a1111111111
OPEN ACCESS
Citation: Jerng J-S, Huang S-F, Liang H-W, Chen
L-C, Lin C-K, Huang H-F, et al. (2017) Workplace
interpersonal conflicts among the healthcare
workers: Retrospective exploration from the
institutional incident reporting system of a
university-affiliated medical center. PLoS ONE 12
(2): e0171696. doi:10.1371/journal.pone.0171696
Editor: Stanley J. Robboy, Duke University,
UNITED STATES
Received: July 6, 2016
Accepted: January 6, 2017
Published: February 6, 2017
Copyright: © 2017 Jerng et al. This is an open
access article distributed under the terms of the
Creative Commons Attribution License, which
permits unrestricted use, distribution, and
reproduction in any medium, provided the original
author and source are credited.
Data Availability Statement: All relevant data are
within the paper and its Supporting Information
files.
Funding: The authors received no specific funding
for this work.
Competing Interests: The authors have declared
that no competing interests exist.
Workplace interpersonal conflicts among the
healthcare workers: Retrospective exploration
from the institutional incident reporting
system of a university-affiliated medical
center
Jih-Shuin Jerng1,2, Szu-Fen Huang1,3, Huey-Wen Liang1,4, Li-Chin Chen1, Chia-Kuei Lin1,
Hsiao-Fang Huang1, Ming-Yuan Hsieh1, Jui-Sheng Sun1,5*
1 Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan, 2 Department of
Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, 3 Department of Nursing, National
Taiwan University Hospital, Taipei, Taiwan, 4 Department of Physical Medicine & Rehabilitation, National
Taiwan University Hospital, Taipei, Taiwan, 5 Department of Orthopedic Surgery, National Taiwan University
Hospital, Taipei, Taiwan
* drjssun@ntuh.gov.tw
Abstract
Objective
There have been concerns about the workplace interpersonal conflict (WIC) among health-
care workers. As healthcare organizations have applied the incident reporting system (IRS)
widely for safety-related incidents, we proposed that this system might provide a channel to
explore the WICs.
Methods
We retrospectively reviewed the reports to the IRS from July 2010 to June 2013 in a medical
center. We identified the WICs and typed these conflicts according to the two foci (task con-
tent/process and interpersonal relationship) and the three properties (disagreement, inter-
ference, and negative emotion), and analyzed relevant data.
Results
Of the 147 incidents with WIC, the most common related processes were patient transfer
(20%), laboratory tests (17%), surgery (16%) and medical imaging (16%). All of the 147 inci-
dents with WIC focused on task content or task process, but 41 (27.9%) also focused on the
interpersonal relationship. We found disagreement, interference, and negative emotion in
91.2%, 88.4%, and 55.8% of the cases, respectively. Nurses (57%) were most often the
reporting workers, while the most common encounter was the nurse-doctor interaction
(33%), and the majority (67%) of the conflicts were experienced concurrently with the inci-
dents. 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). The doctors
PLOS ONE | DOI:10.1371/journal.pone.0171696 February 6, 2017 1 / 13
a1111111111
a1111111111
a1111111111
a1111111111
a1111111111
OPEN ACCESS
Citation: Jerng J-S, Huang S-F, Liang H-W, Chen
L-C, Lin C-K, Huang H-F, et al. (2017) Workplace
interpersonal conflicts among the healthcare
workers: Retrospective exploration from the
institutional incident reporting system of a
university-affiliated medical center. PLoS ONE 12
(2): e0171696. doi:10.1371/journal.pone.0171696
Editor: Stanley J. Robboy, Duke University,
UNITED STATES
Received: July 6, 2016
Accepted: January 6, 2017
Published: February 6, 2017
Copyright: © 2017 Jerng et al. This is an open
access article distributed under the terms of the
Creative Commons Attribution License, which
permits unrestricted use, distribution, and
reproduction in any medium, provided the original
author and source are credited.
Data Availability Statement: All relevant data are
within the paper and its Supporting Information
files.
Funding: The authors received no specific funding
for this work.
Competing Interests: The authors have declared
that no competing interests exist.
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were more frequently as the reporter when the conflicts focused on the interpersonal rela-
tionship (34.1%) than not on it (17.0%). The distributions of worker job types were similar
between those with and without negative emotion (p = 0.125).
Conclusions
The institutional IRS is a useful place to report the workplace interpersonal conflicts actively.
The healthcare systems need to improve the channels to communicate, manage and
resolve these conflicts.
Introduction
Interpersonal conflict is an important type of conflict [1] that a variety of its nomen
exists, such as task, process, information, emotional and relationship conflicts [2–4
of conflict is often regarded as a negative term because individual interests are pe
opposed or negatively affected [5]. Recently, there have been concerns about wor
personal conflict (WIC) and its impact on the healthcare system and the workers [6
of individuals, including doctors, nurses, co-workers, managers and administrative
might have experienced conflicts [7]. The WICs were also commonly encountered
care units [8], operating rooms [9] and emergency rooms [10, 11]. These high-risk
areas often require intensive patient caring, timely decision-making, and multidisc
coordination among the workers [12]. WICs might be the consequence of poor com
tion [13], excessive work stress [14] or unsolved competing priorities of tasks [15]
oped, the WIC might, in turn, possess deleterious effects on the workers, such as in
with the team performance and reduction of staff satisfaction [16]. Furthermore, re
associated WICs with lower-quality patient care, higher rates of medical errors, a h
of staff burnout, and greater direct and indirect costs of care [17].
Since these consequences might compromise patient safety, we proposed that t
of the healthcare system might report interpersonal conflicts in the process of pati
when they report patient safety events. Many healthcare systems worldwide have
the incident reporting system (IRS) to understand the occurrence of patient safety
Since 2000, our institution has established an IRS for the workers in the hospital to
safety-related events in the hospital. Previous reports of the studies on the WIC in
care settings applied mainly questionnaire investigations and surveys [12, 19] whi
case-specific descriptions of the WIC were lacking, probably because reporting dire
the workers might require an adequate channel. Whether or no the IRS might also
ble channel for reporting the WIC had remained unclear.
Materials and methods
Study design and settings
This retrospective study was conducted at the National Taiwan University Hospital
to analyze the collected data from the incident reporting system (IRS) of the institu
July 2010 to June 2013. The Research Ethical Committee A of the National Taiwan U
Hospital approved the study and exempted the informed consents.
The NTUH was a 2,300-bed, university-affiliated medical center, containing abou
full-time employees, which included more than 1,000 doctors and 2,700 nurses. In
Workplace interpersonal conflicts and incident reporting system
PLOS ONE | DOI:10.1371/journal.pone.0171696 February 6, 2017 2 / 13
tionship (34.1%) than not on it (17.0%). The distributions of worker job types were similar
between those with and without negative emotion (p = 0.125).
Conclusions
The institutional IRS is a useful place to report the workplace interpersonal conflicts actively.
The healthcare systems need to improve the channels to communicate, manage and
resolve these conflicts.
Introduction
Interpersonal conflict is an important type of conflict [1] that a variety of its nomen
exists, such as task, process, information, emotional and relationship conflicts [2–4
of conflict is often regarded as a negative term because individual interests are pe
opposed or negatively affected [5]. Recently, there have been concerns about wor
personal conflict (WIC) and its impact on the healthcare system and the workers [6
of individuals, including doctors, nurses, co-workers, managers and administrative
might have experienced conflicts [7]. The WICs were also commonly encountered
care units [8], operating rooms [9] and emergency rooms [10, 11]. These high-risk
areas often require intensive patient caring, timely decision-making, and multidisc
coordination among the workers [12]. WICs might be the consequence of poor com
tion [13], excessive work stress [14] or unsolved competing priorities of tasks [15]
oped, the WIC might, in turn, possess deleterious effects on the workers, such as in
with the team performance and reduction of staff satisfaction [16]. Furthermore, re
associated WICs with lower-quality patient care, higher rates of medical errors, a h
of staff burnout, and greater direct and indirect costs of care [17].
Since these consequences might compromise patient safety, we proposed that t
of the healthcare system might report interpersonal conflicts in the process of pati
when they report patient safety events. Many healthcare systems worldwide have
the incident reporting system (IRS) to understand the occurrence of patient safety
Since 2000, our institution has established an IRS for the workers in the hospital to
safety-related events in the hospital. Previous reports of the studies on the WIC in
care settings applied mainly questionnaire investigations and surveys [12, 19] whi
case-specific descriptions of the WIC were lacking, probably because reporting dire
the workers might require an adequate channel. Whether or no the IRS might also
ble channel for reporting the WIC had remained unclear.
Materials and methods
Study design and settings
This retrospective study was conducted at the National Taiwan University Hospital
to analyze the collected data from the incident reporting system (IRS) of the institu
July 2010 to June 2013. The Research Ethical Committee A of the National Taiwan U
Hospital approved the study and exempted the informed consents.
The NTUH was a 2,300-bed, university-affiliated medical center, containing abou
full-time employees, which included more than 1,000 doctors and 2,700 nurses. In
Workplace interpersonal conflicts and incident reporting system
PLOS ONE | DOI:10.1371/journal.pone.0171696 February 6, 2017 2 / 13
hospital established the institutional IRS for safety-related events. It initially opera
a paper-based reporting process, and then adopted on-line reporting mechanism in
integrating into the hospital’s intranet. The reporting of the safety incident was vo
non-punitive, focused on safety-related events or concerns to the patients, worker
tors. In addition to structured checkboxes for data entry, the online page also prov
text field for the reporter to describe the events. After the reporting, the Center for
Management managed the data. The staff of this centralized unit of this institution
incidents, collected and analyzed pertinent information, performed important discu
with the workers from where the events occurred, and participated in the improve
activities.
The definition and severity of the safety-related incidents were classified as prev
described in the literature [20–22]. Briefly, a safety incident or event is an unexpec
tended event, which could have led to or did result in harm of the involved person.
event was an injury caused during the health care process rather than by the unde
or condition of the individual. A no-harm event was an event, which resulted in no
the person, or the effect was minor that the individual could not even feel it. A nea
was an event that may cause accident, injury or illness, but did not happen becaus
tional or timely intervention [20–22]. We excluded the reports from the database o
incidents were not related to any health care or service process for the patients, or
to the health care environment provided for the care of the patients.
Review of incidents and identification of workplace interpersonal
conflicts
Our team of two doctors, three nurses and two quality managers from the Instituti
for Quality Management reviewed all available incident reports. All team members
least one year’s training in the process. Four of the seven reviewers independently
reports they considered to contain the descriptions compatible with workforce con
recorded the type using the classification in Table 1 below. The three other membe
ticipated in the assessment of selected reports and authenticated the consensus r
were de-identified and analyzed anonymously.
Interpersonal conflict
We classified workplace conflicts using a modified Barki and Hartwick typology bas
[4] (Table 1). We defined interpersonal conflict as “a dynamic process that occurs
interdependent individuals, groups, or both, as they experience negative emotiona
Table 1. Workplace Interpersonal Conflicts: Summary of Definitions* .
Property of the
WIC
Focus of the WIC
Task Content or Task Process Interpersonal Relationship
Disagreement Disagreement with other about what should be done or how should be done in
a task
Disagreement with the other’s personal values,
views, preferences, etc.
Interference Preventing the other from doing what they think should be done in a task or
how a task should be done
Preventing the other from doing things unrelated to a
task
Negative emotion Anger and frustration directed to the other about what should be done in a task
or how a task should be done
Anger and frustration directed to the other as a
person
*Adopted from Barki and Harwick[4].
doi:10.1371/journal.pone.0171696.t001
Workplace interpersonal conflicts and incident reporting system
PLOS ONE | DOI:10.1371/journal.pone.0171696 February 6, 2017 3 / 13
a paper-based reporting process, and then adopted on-line reporting mechanism in
integrating into the hospital’s intranet. The reporting of the safety incident was vo
non-punitive, focused on safety-related events or concerns to the patients, worker
tors. In addition to structured checkboxes for data entry, the online page also prov
text field for the reporter to describe the events. After the reporting, the Center for
Management managed the data. The staff of this centralized unit of this institution
incidents, collected and analyzed pertinent information, performed important discu
with the workers from where the events occurred, and participated in the improve
activities.
The definition and severity of the safety-related incidents were classified as prev
described in the literature [20–22]. Briefly, a safety incident or event is an unexpec
tended event, which could have led to or did result in harm of the involved person.
event was an injury caused during the health care process rather than by the unde
or condition of the individual. A no-harm event was an event, which resulted in no
the person, or the effect was minor that the individual could not even feel it. A nea
was an event that may cause accident, injury or illness, but did not happen becaus
tional or timely intervention [20–22]. We excluded the reports from the database o
incidents were not related to any health care or service process for the patients, or
to the health care environment provided for the care of the patients.
Review of incidents and identification of workplace interpersonal
conflicts
Our team of two doctors, three nurses and two quality managers from the Instituti
for Quality Management reviewed all available incident reports. All team members
least one year’s training in the process. Four of the seven reviewers independently
reports they considered to contain the descriptions compatible with workforce con
recorded the type using the classification in Table 1 below. The three other membe
ticipated in the assessment of selected reports and authenticated the consensus r
were de-identified and analyzed anonymously.
Interpersonal conflict
We classified workplace conflicts using a modified Barki and Hartwick typology bas
[4] (Table 1). We defined interpersonal conflict as “a dynamic process that occurs
interdependent individuals, groups, or both, as they experience negative emotiona
Table 1. Workplace Interpersonal Conflicts: Summary of Definitions* .
Property of the
WIC
Focus of the WIC
Task Content or Task Process Interpersonal Relationship
Disagreement Disagreement with other about what should be done or how should be done in
a task
Disagreement with the other’s personal values,
views, preferences, etc.
Interference Preventing the other from doing what they think should be done in a task or
how a task should be done
Preventing the other from doing things unrelated to a
task
Negative emotion Anger and frustration directed to the other about what should be done in a task
or how a task should be done
Anger and frustration directed to the other as a
person
*Adopted from Barki and Harwick[4].
doi:10.1371/journal.pone.0171696.t001
Workplace interpersonal conflicts and incident reporting system
PLOS ONE | DOI:10.1371/journal.pone.0171696 February 6, 2017 3 / 13
to perceived disagreements and interference with the attainment of their goals.” T
of focus of the interpersonal conflict identified included the conflicts related to task
process, and the conflicts related to the interpersonal relationship. We explored ea
agreement, interference, and negative emotion as the property of the WICs. Disag
reflects cognitive difference based on a divergence of values, needs, interests, opi
goals. Interference indicates conflict due to behavioral difference and used by one
interfere with or oppose another party’s attaining its interests, objectives or goals.
haviors include debate, argumentation, competition, political maneuvering, backst
aggression, hostility, and destruction. Negative emotions produce conflict and und
jealousy, anger, anxiety, and frustrations [4]. Table 1 depicts the typology of the c
of WICs used throughout this study. In each incident, the investigators identified a
focus and property of conflict. Based on the text descriptions from the reporters an
after discussions, the investigators classified the incident-related processes that w
the WICs and then identified the tasks that were considered most closely related to
rence of WICs.
Collection of data
The investigators collected the following data for analysis: dates, times, place, and
where the incidents and conflicts occurred, types and categories of the reported in
types of the reporting workers and employees involved in the WIP, and working ex
the reporting workers. Records were de-identified and analyzed anonymously. We
included the data regarding the types of the conflicts into analysis together with th
data.
Statistical analysis
We first analyzed the health care characteristics relating to the development of WI
the reported incidents, such as health care related processes, worker types involve
development of WIP, and severity of the reported incidents. We then described the
the WICs, based on the focus of the conflicts. We then further explore the possible
of job scenario and the development of WIP by comparing different characteristics
groups.
Results are summarized and expressed as counts and percentage for nominal va
median with range for ages. The chi-square test was used to compare across differ
ries, such as incident types, job types of the workers. The Mann-Whitney U-test wa
compare the age between groups of workers. Statistical analysis was performed us
22 Software (SPSS Corp., Chicago, IL, USA). A P<0.05 was considered statistically s
Results
During the 3-year study period, a total of 8,555 safety-related incidents (Table 2) w
hospital-wide, with an average of 237 events every month. Among the 8,555 safet
dents, 147 (1.7%) had WIC. Strikingly none involved fall events and tubing/line eve
few involved medication. 96% involved health care or service processes (Table 3).
monly, they involved the transfer of patients between units or departments (20%),
tests (17%), surgery (16%) and medical image examination and interventions (16%
category of the incident-related processes, the first tasks were the most frequent (
44%) in these processes associated with the conflict, such as the decision to start
the requesting for the care process and the scheduling for the process. (Table 3).
Workplace interpersonal conflicts and incident reporting system
PLOS ONE | DOI:10.1371/journal.pone.0171696 February 6, 2017 4 / 13
of focus of the interpersonal conflict identified included the conflicts related to task
process, and the conflicts related to the interpersonal relationship. We explored ea
agreement, interference, and negative emotion as the property of the WICs. Disag
reflects cognitive difference based on a divergence of values, needs, interests, opi
goals. Interference indicates conflict due to behavioral difference and used by one
interfere with or oppose another party’s attaining its interests, objectives or goals.
haviors include debate, argumentation, competition, political maneuvering, backst
aggression, hostility, and destruction. Negative emotions produce conflict and und
jealousy, anger, anxiety, and frustrations [4]. Table 1 depicts the typology of the c
of WICs used throughout this study. In each incident, the investigators identified a
focus and property of conflict. Based on the text descriptions from the reporters an
after discussions, the investigators classified the incident-related processes that w
the WICs and then identified the tasks that were considered most closely related to
rence of WICs.
Collection of data
The investigators collected the following data for analysis: dates, times, place, and
where the incidents and conflicts occurred, types and categories of the reported in
types of the reporting workers and employees involved in the WIP, and working ex
the reporting workers. Records were de-identified and analyzed anonymously. We
included the data regarding the types of the conflicts into analysis together with th
data.
Statistical analysis
We first analyzed the health care characteristics relating to the development of WI
the reported incidents, such as health care related processes, worker types involve
development of WIP, and severity of the reported incidents. We then described the
the WICs, based on the focus of the conflicts. We then further explore the possible
of job scenario and the development of WIP by comparing different characteristics
groups.
Results are summarized and expressed as counts and percentage for nominal va
median with range for ages. The chi-square test was used to compare across differ
ries, such as incident types, job types of the workers. The Mann-Whitney U-test wa
compare the age between groups of workers. Statistical analysis was performed us
22 Software (SPSS Corp., Chicago, IL, USA). A P<0.05 was considered statistically s
Results
During the 3-year study period, a total of 8,555 safety-related incidents (Table 2) w
hospital-wide, with an average of 237 events every month. Among the 8,555 safet
dents, 147 (1.7%) had WIC. Strikingly none involved fall events and tubing/line eve
few involved medication. 96% involved health care or service processes (Table 3).
monly, they involved the transfer of patients between units or departments (20%),
tests (17%), surgery (16%) and medical image examination and interventions (16%
category of the incident-related processes, the first tasks were the most frequent (
44%) in these processes associated with the conflict, such as the decision to start
the requesting for the care process and the scheduling for the process. (Table 3).
Workplace interpersonal conflicts and incident reporting system
PLOS ONE | DOI:10.1371/journal.pone.0171696 February 6, 2017 4 / 13
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Table 4 summarizes the characteristics of the workers and working condition. M
monly, the nurses were the reporter (57%), in a nurse-doctor encounter (33%). The
occurred most frequently during telephone communication (63%), at the same tim
incident developed (60%), during the daytime nursing shift (51%) (Table 4). We did
any WIC in the same unit. The median age of the reporters was 7 years (range 0–3
The working experience was similar among different types of workers (p = 0.055),
the doctors tended to have less working years (median, 4 years; range, 0–31 years
Table 5 shows the types of WIC. All of the 147 incidents with WIC focused on tas
or task process, but 41 (27.9%) also focused on the interpersonal relationship (Tab
shows the Venn diagram to indicate different combinations of WIC properties in the
dents. Most (85.7%) of the cases focused on the task content or task process had a
property of conflicts. This included especially the “disagreement + interference +
emotion” combination (66 cases, 44.9%) and the “disagreement + interference” c
(54 cases, 36.7%) (Fig 1A). On the contrary, the majority (25 cases, 61.0%) the WI
on the interpersonal relationship had a single property of negative emotion withou
description of disagreement or interference (Fig 1B). For all of the 147 cases, 82 (5
negative emotion. These included 42 (28.6%) focused on task content or process,
the interpersonal relationship, and 33 (22.4%) on both. Table 6 shows examples of
descriptions from the workers considered as having the WIC in different categories
As shown in Table 7, there was a significant difference in the distribution of work
types between cases with or without a focus on the interpersonal relationship (p =
Nurses accounted for a lower proportion of the reporters of cases with interperson
ship than the cases without this type of conflict (34.1% vs. 66.0%). However, cases
personal relationship had more doctors involved than those without this conflict (3
17.0%). There working experience of the employee who reported interpersonal rel
(n = 41; median, 6 years; range, 1–31 years) was similar to those who did not (n =
(median, 8 years; range, 0–31 years) (p = 0.397).
In the 82 incidents with negative emotion, 45 (54.9%) were described by the rep
while 15 (18.3%) by the counterpart workers and 22 (26.8%) by both sides involve
flict. Also, 26 (31.7%) described disruptive languages whereas 9 (11.0%) had disru
cal behaviors. Although the job types were similar between incidents with negative
and those without (p = 0.125), there were more doctors as the reporters for WIC in
a negative emotion than the cases without (28.0% vs. 13.8%) (Table 8). This result
Table 2. Safety-related incidents during the study period.
Type Number (%)
Fall 2,041 (23.9%)
Indwelling tubes and lines 1,577 (18.4%)
Medication 1,504 (17.6%)
Transfusion 827 (9.7%)
Diagnostic procedures 503 (5.9%)
General bedside care 184 (2.2%)
Self hurting 164 (1.9%)
Unexpected cardiopulmonary resuscitation 139 (1.6%)
Medical device 45 (0.5%)
Anesthesia 10 (0.1%)
Others 876 (10.2%)
Total 8,555
doi:10.1371/journal.pone.0171696.t002
Workplace interpersonal conflicts and incident reporting system
PLOS ONE | DOI:10.1371/journal.pone.0171696 February 6, 2017 5 / 13
monly, the nurses were the reporter (57%), in a nurse-doctor encounter (33%). The
occurred most frequently during telephone communication (63%), at the same tim
incident developed (60%), during the daytime nursing shift (51%) (Table 4). We did
any WIC in the same unit. The median age of the reporters was 7 years (range 0–3
The working experience was similar among different types of workers (p = 0.055),
the doctors tended to have less working years (median, 4 years; range, 0–31 years
Table 5 shows the types of WIC. All of the 147 incidents with WIC focused on tas
or task process, but 41 (27.9%) also focused on the interpersonal relationship (Tab
shows the Venn diagram to indicate different combinations of WIC properties in the
dents. Most (85.7%) of the cases focused on the task content or task process had a
property of conflicts. This included especially the “disagreement + interference +
emotion” combination (66 cases, 44.9%) and the “disagreement + interference” c
(54 cases, 36.7%) (Fig 1A). On the contrary, the majority (25 cases, 61.0%) the WI
on the interpersonal relationship had a single property of negative emotion withou
description of disagreement or interference (Fig 1B). For all of the 147 cases, 82 (5
negative emotion. These included 42 (28.6%) focused on task content or process,
the interpersonal relationship, and 33 (22.4%) on both. Table 6 shows examples of
descriptions from the workers considered as having the WIC in different categories
As shown in Table 7, there was a significant difference in the distribution of work
types between cases with or without a focus on the interpersonal relationship (p =
Nurses accounted for a lower proportion of the reporters of cases with interperson
ship than the cases without this type of conflict (34.1% vs. 66.0%). However, cases
personal relationship had more doctors involved than those without this conflict (3
17.0%). There working experience of the employee who reported interpersonal rel
(n = 41; median, 6 years; range, 1–31 years) was similar to those who did not (n =
(median, 8 years; range, 0–31 years) (p = 0.397).
In the 82 incidents with negative emotion, 45 (54.9%) were described by the rep
while 15 (18.3%) by the counterpart workers and 22 (26.8%) by both sides involve
flict. Also, 26 (31.7%) described disruptive languages whereas 9 (11.0%) had disru
cal behaviors. Although the job types were similar between incidents with negative
and those without (p = 0.125), there were more doctors as the reporters for WIC in
a negative emotion than the cases without (28.0% vs. 13.8%) (Table 8). This result
Table 2. Safety-related incidents during the study period.
Type Number (%)
Fall 2,041 (23.9%)
Indwelling tubes and lines 1,577 (18.4%)
Medication 1,504 (17.6%)
Transfusion 827 (9.7%)
Diagnostic procedures 503 (5.9%)
General bedside care 184 (2.2%)
Self hurting 164 (1.9%)
Unexpected cardiopulmonary resuscitation 139 (1.6%)
Medical device 45 (0.5%)
Anesthesia 10 (0.1%)
Others 876 (10.2%)
Total 8,555
doi:10.1371/journal.pone.0171696.t002
Workplace interpersonal conflicts and incident reporting system
PLOS ONE | DOI:10.1371/journal.pone.0171696 February 6, 2017 5 / 13
contrast to the finding that there were fewer nurses as the reporter in the case wit
emotion (50.0% vs. 66.2%). There was no difference of work experience between t
who reported negative emotions (n = 82; median, 5 years; range, 1–25 years) and
(n = 65) (median, 8 years; range, 0–31 years) (p = 0.265).
Table 9 summarizes the comparison of the distributions of incident types based
severity of outcome between the two groups that contained (n = 147) or did not co
(n = 8408) WIC, which was statistically different (P<0.0001). The incidents with WI
Table 3. Workplace interpersonal conflicts: Related processes and tasks (n = 147).
Incident-related process Number (%) Conflict-associated tasks in the process Number (%)
Patient transfer 28 (20) Decision on transfer 25 (17)
Preparation for transfer 2 (1)
Handoff 1 (1)
Laboratory tests 25 (17) Test ordering 1 (1)
Sample preparation 11 (7)
Sample transporting 2 (1)
Turnaround time 10 (7)
Report maintenance 1 (1)
Surgery 24 (16) Scheduling 10 (7)
Preoperative preparation 5 (3)
In-hospital transport 6 (4)
Intraoperative care 1 (1)
Postoperative care 1 (1)
Operation note entry 1 (1)
Medical image examinations and interventions 23 (16) Scheduling 9 (6)
Preparation for examination 3 (2)
In-hospital transport 6 (4)
Continuity of care 2 (1)
Patient identification 1 (1)
Post-examination care 1 (1)
Result reporting 1 (1)
Consultations 13 (9) Request for consultation 10 (7)
Equipment preparation 2 (1)
Consultation response 1 (1)
Maintenance of facility and equipment 12 (8) Supply turnaround time 5 (3)
Facility & equipment maintenance 7 (5)
Transfusions 6 (4) Request for transfusion 6 (4)
Medication 6 (4) Medication order 1 (1)
Dispensing 2 (1)
In-hospital transport of medication 2 (1)
Adverse reaction reporting 1 (1)
Resuscitations 3 (2) Decision on resuscitation 1 (1)
Cooperation during resuscitation 2 (1)
Outpatient clinic 3 (2) Scheduling 2 (1)
Medical record maintenance 1 (1)
Emergency Room Visit 1 (1) Patient identification 1 (1)
Dialysis 1 (1) Equipment maintenance 1 (1)
Other 2 (1) Patient monitoring 1 (1)
IT system maintenance 1 (1)
doi:10.1371/journal.pone.0171696.t003
Workplace interpersonal conflicts and incident reporting system
PLOS ONE | DOI:10.1371/journal.pone.0171696 February 6, 2017 6 / 13
emotion (50.0% vs. 66.2%). There was no difference of work experience between t
who reported negative emotions (n = 82; median, 5 years; range, 1–25 years) and
(n = 65) (median, 8 years; range, 0–31 years) (p = 0.265).
Table 9 summarizes the comparison of the distributions of incident types based
severity of outcome between the two groups that contained (n = 147) or did not co
(n = 8408) WIC, which was statistically different (P<0.0001). The incidents with WI
Table 3. Workplace interpersonal conflicts: Related processes and tasks (n = 147).
Incident-related process Number (%) Conflict-associated tasks in the process Number (%)
Patient transfer 28 (20) Decision on transfer 25 (17)
Preparation for transfer 2 (1)
Handoff 1 (1)
Laboratory tests 25 (17) Test ordering 1 (1)
Sample preparation 11 (7)
Sample transporting 2 (1)
Turnaround time 10 (7)
Report maintenance 1 (1)
Surgery 24 (16) Scheduling 10 (7)
Preoperative preparation 5 (3)
In-hospital transport 6 (4)
Intraoperative care 1 (1)
Postoperative care 1 (1)
Operation note entry 1 (1)
Medical image examinations and interventions 23 (16) Scheduling 9 (6)
Preparation for examination 3 (2)
In-hospital transport 6 (4)
Continuity of care 2 (1)
Patient identification 1 (1)
Post-examination care 1 (1)
Result reporting 1 (1)
Consultations 13 (9) Request for consultation 10 (7)
Equipment preparation 2 (1)
Consultation response 1 (1)
Maintenance of facility and equipment 12 (8) Supply turnaround time 5 (3)
Facility & equipment maintenance 7 (5)
Transfusions 6 (4) Request for transfusion 6 (4)
Medication 6 (4) Medication order 1 (1)
Dispensing 2 (1)
In-hospital transport of medication 2 (1)
Adverse reaction reporting 1 (1)
Resuscitations 3 (2) Decision on resuscitation 1 (1)
Cooperation during resuscitation 2 (1)
Outpatient clinic 3 (2) Scheduling 2 (1)
Medical record maintenance 1 (1)
Emergency Room Visit 1 (1) Patient identification 1 (1)
Dialysis 1 (1) Equipment maintenance 1 (1)
Other 2 (1) Patient monitoring 1 (1)
IT system maintenance 1 (1)
doi:10.1371/journal.pone.0171696.t003
Workplace interpersonal conflicts and incident reporting system
PLOS ONE | DOI:10.1371/journal.pone.0171696 February 6, 2017 6 / 13
harm to the patients than those without reported conflicts (Table 9). None of the p
ciated with the events containing WIC died in the hospital; this was in contrast with
patients linked to the incidents that did not have WIC died at hospital discharge.
Discussion
The main finding of this study was that the employee of the hospital applied the in
reporting system (IRS) to actively report the workplace interpersonal conflicts (WIC
although the IRS was originally designed for the reporting of safety events.
Our study provided the evidence of WIC as the dedicated workers of the instituti
described the scenarios and encounters related to the conflicts in the incident repo
tem. Although we identified only 1.72% of the reported safety incidents as having
there might be a high probability of underestimation. One of the explanations is th
tution originally designed the IRS for the reporting of safety incidents that the desc
the reporters focused mainly on the events rather than the conflicts. Moreover, the
were the interpersonal conflicts between people of different units. Individuals in th
or department might report the conflicts to the same one supervisor, rather than t
fact, we did not find an intra-unit WIC in this study. Also, the culture of the healthc
ronment, as well as the social background, might also influence the reporting of W
Table 4. Workplace interpersonal conflicts: Summary of 147 incidents.
Description Number (%)
Total number of safety-related incidents with WIC 147 (100)
Reporting worker job type
Nurse 84 (57)
Doctor 32 (22)
Other healthcare professional 24 (16)
Supporting department worker 7 (5)
Working experience of the incident reporter (year, mean, range) 9.3 (0.2–30.9)
Job types of the workers encountered in the WIC
Nurse-doctor 48 (33)
Nurse-other healthcare professional 36 (24)
Doctor-doctor 18 (12)
Nurse-nurse 14 (10)
Nurse-supporting department worker 10 (7)
Doctor-other healthcare professional 6 (4)
Doctor-supporting department worker 5 (3)
Other encounters 10 (8)
Interaction and communication scenario of the WIC
Face-to-face interaction 54 (37)
Telephone communication 93 (63)
Timing of the occurrence of conflict in relation to the incident
Conflict occurred before the incident 4 (3)
Conflict occurred at the same time with the incident 89 (60)
Conflict occurred after the incident 54 (37)
Timing of the incident occurrence in relation to nursing shift
Day shift 75 (51)
Evening shift 53 (36)
Night shift 19 (13)
doi:10.1371/journal.pone.0171696.t004
Workplace interpersonal conflicts and incident reporting system
PLOS ONE | DOI:10.1371/journal.pone.0171696 February 6, 2017 7 / 13
ciated with the events containing WIC died in the hospital; this was in contrast with
patients linked to the incidents that did not have WIC died at hospital discharge.
Discussion
The main finding of this study was that the employee of the hospital applied the in
reporting system (IRS) to actively report the workplace interpersonal conflicts (WIC
although the IRS was originally designed for the reporting of safety events.
Our study provided the evidence of WIC as the dedicated workers of the instituti
described the scenarios and encounters related to the conflicts in the incident repo
tem. Although we identified only 1.72% of the reported safety incidents as having
there might be a high probability of underestimation. One of the explanations is th
tution originally designed the IRS for the reporting of safety incidents that the desc
the reporters focused mainly on the events rather than the conflicts. Moreover, the
were the interpersonal conflicts between people of different units. Individuals in th
or department might report the conflicts to the same one supervisor, rather than t
fact, we did not find an intra-unit WIC in this study. Also, the culture of the healthc
ronment, as well as the social background, might also influence the reporting of W
Table 4. Workplace interpersonal conflicts: Summary of 147 incidents.
Description Number (%)
Total number of safety-related incidents with WIC 147 (100)
Reporting worker job type
Nurse 84 (57)
Doctor 32 (22)
Other healthcare professional 24 (16)
Supporting department worker 7 (5)
Working experience of the incident reporter (year, mean, range) 9.3 (0.2–30.9)
Job types of the workers encountered in the WIC
Nurse-doctor 48 (33)
Nurse-other healthcare professional 36 (24)
Doctor-doctor 18 (12)
Nurse-nurse 14 (10)
Nurse-supporting department worker 10 (7)
Doctor-other healthcare professional 6 (4)
Doctor-supporting department worker 5 (3)
Other encounters 10 (8)
Interaction and communication scenario of the WIC
Face-to-face interaction 54 (37)
Telephone communication 93 (63)
Timing of the occurrence of conflict in relation to the incident
Conflict occurred before the incident 4 (3)
Conflict occurred at the same time with the incident 89 (60)
Conflict occurred after the incident 54 (37)
Timing of the incident occurrence in relation to nursing shift
Day shift 75 (51)
Evening shift 53 (36)
Night shift 19 (13)
doi:10.1371/journal.pone.0171696.t004
Workplace interpersonal conflicts and incident reporting system
PLOS ONE | DOI:10.1371/journal.pone.0171696 February 6, 2017 7 / 13
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some cultural contexts, the organization might not encourage the reporting of con
because of the emphasis on harmony to avoid conflict[23]. Nevertheless, we sugge
care system should promote the reporting of the conflicts. Other authors also sugg
the organizations asked their people to discuss conflicts openly and productively to
the interpersonal relationships [24].
Traditionally, interpersonal conflicts among nurses were called ‘horizontal violen
However, we found a substantial number of WICs focusing on interpersonal relation
across different disciplines and units. This finding suggests that horizontal violence
Table 5. Workplace interpersonal conflicts: Types of the 147 incidents.
Property of the
WIC
Focus of the WIC
Task Content or Task Process (147
[100%])
Interpersonal Relationship (41
[27.9%])
Either Focus Combined Number (147
[100%])
Disagreement 134 (91.2%) 16 (10.9%) 134 (91.2%)
Interference 130 (88.4%) 8 (5.4%) 130 (88.4%)
Negative emotion 75 (51.0%) 40 (27.2%) 82 (55.8%)
doi:10.1371/journal.pone.0171696.t005
Fig 1. Venn diagrams of the workplace interpersonal conflicts. (A) Conflicts focused on the task process/
task content. (B) Conflicts focused on the interpersonal relationship. D = disagreement; I = interference;
N = negative emotion.
doi:10.1371/journal.pone.0171696.g001
Workplace interpersonal conflicts and incident reporting system
PLOS ONE | DOI:10.1371/journal.pone.0171696 February 6, 2017 8 / 13
because of the emphasis on harmony to avoid conflict[23]. Nevertheless, we sugge
care system should promote the reporting of the conflicts. Other authors also sugg
the organizations asked their people to discuss conflicts openly and productively to
the interpersonal relationships [24].
Traditionally, interpersonal conflicts among nurses were called ‘horizontal violen
However, we found a substantial number of WICs focusing on interpersonal relation
across different disciplines and units. This finding suggests that horizontal violence
Table 5. Workplace interpersonal conflicts: Types of the 147 incidents.
Property of the
WIC
Focus of the WIC
Task Content or Task Process (147
[100%])
Interpersonal Relationship (41
[27.9%])
Either Focus Combined Number (147
[100%])
Disagreement 134 (91.2%) 16 (10.9%) 134 (91.2%)
Interference 130 (88.4%) 8 (5.4%) 130 (88.4%)
Negative emotion 75 (51.0%) 40 (27.2%) 82 (55.8%)
doi:10.1371/journal.pone.0171696.t005
Fig 1. Venn diagrams of the workplace interpersonal conflicts. (A) Conflicts focused on the task process/
task content. (B) Conflicts focused on the interpersonal relationship. D = disagreement; I = interference;
N = negative emotion.
doi:10.1371/journal.pone.0171696.g001
Workplace interpersonal conflicts and incident reporting system
PLOS ONE | DOI:10.1371/journal.pone.0171696 February 6, 2017 8 / 13
more common than previously perceived. Although researchers reported that new
in the first year of their practice might encounter horizontal violence [25], we show
occurrence of WICs focusing on the interpersonal relationship was not related to w
Table 6. Workplace interpersonal conflicts: Examples.
Focus Category Focus Property Summaries of Text Descriptions*
Task content or task
process
Disagreement ●The nurse reported that the lab technician insisted on not having received the sample, but the nurse had
checked the tracking system and was sure that they had submitted the sample.
●The nurse reported that the patient should not stay at the emergency room because the patient should be
transported directly to the ICU.
●The technician said that the doctors should not cancel the order of blood transfusion by telephone despite
knowing that they might be busy in the Operation Room.
Interference ●The nurses transported the patient to the general ward, but on arrival, they were asked to transport this
patient to the operation room without confirmed message.
●The anesthesiologist was unable to key in assessment data to the electronic record system because the
requesting department did not establish an eligible patient list.
●The doctor asked that the nurse should stay at the bedside during the examination, which was declined by
the nurse.
Negative
emotion
●The nurses expressed their anger about the operation schedule that resulted in prolonged waiting for the
patients.
●The nurse was surprised and upset about that the staff transported the patient to the ICU before confirmation
of the transfer timing.
●The nurse expressed a very frustrating situation to wait for such a long time for gathering all of the team
members to transport the patient for radiologic examination and intervention.
Interpersonal
relationship
Disagreement ●The nurse at the ICU received the comments from a doctor unrelated to the care team for the indicated
patient and disagreed with the comment by stating that the doctor had no right to intervene the care for that
patient.
●The nurse reported that they did not need to perform the job they are not supposed to do, such as explain to
the patients about the operation procedure.
●The nurse reported that the way the indicated doctor spoke to the nurse was not acceptable.
Interference ●The doctor asked the staff to do more works that another discipline should do, which bothered the nurses.
●A doctor who was unrelated to the care team for the patient tried to put opinions into the patient care.
●The doctor unrelated to the Emergency Room and the patient care team asked the Emergency Room staff to
admit the patient to the ward.
Negative
emotion
●The nurse reported her staff members were very upset about the poor attitude and interaction from the
transferring unit.
●The lab technician stated the frustration and lack of respect during the contact with nurses for laboratory
sample issue.
●The doctor expressed his anger about the nurse repeatedly asked him to correct the medication order
without confirmation.
*Translated from the original Chinese texts.
doi:10.1371/journal.pone.0171696.t006
Table 7. Personnel involved and interpersonal relationship.
Worker job type Conflicts focused on the interpersonal relationship
Present (n = 41) Absent (n = 106) p-value
Reporter of the conflict in the incident
Doctor 14 (34.1%) 18 (17.0%) 0.0064
Nurse 14 (34.1%) 70 (66.0%)
Other healthcare professions 10 (24.4%) 14 (13.2%)
Supporting worker 3 (7.3%) 4 (3.8%)
Doctor reportedly involved in the conflict
Yes 27 (65.9%) 51 (48.1%) 0.053
No 14 (34.1%) 55 (51.9%)
doi:10.1371/journal.pone.0171696.t007
Workplace interpersonal conflicts and incident reporting system
PLOS ONE | DOI:10.1371/journal.pone.0171696 February 6, 2017 9 / 13
in the first year of their practice might encounter horizontal violence [25], we show
occurrence of WICs focusing on the interpersonal relationship was not related to w
Table 6. Workplace interpersonal conflicts: Examples.
Focus Category Focus Property Summaries of Text Descriptions*
Task content or task
process
Disagreement ●The nurse reported that the lab technician insisted on not having received the sample, but the nurse had
checked the tracking system and was sure that they had submitted the sample.
●The nurse reported that the patient should not stay at the emergency room because the patient should be
transported directly to the ICU.
●The technician said that the doctors should not cancel the order of blood transfusion by telephone despite
knowing that they might be busy in the Operation Room.
Interference ●The nurses transported the patient to the general ward, but on arrival, they were asked to transport this
patient to the operation room without confirmed message.
●The anesthesiologist was unable to key in assessment data to the electronic record system because the
requesting department did not establish an eligible patient list.
●The doctor asked that the nurse should stay at the bedside during the examination, which was declined by
the nurse.
Negative
emotion
●The nurses expressed their anger about the operation schedule that resulted in prolonged waiting for the
patients.
●The nurse was surprised and upset about that the staff transported the patient to the ICU before confirmation
of the transfer timing.
●The nurse expressed a very frustrating situation to wait for such a long time for gathering all of the team
members to transport the patient for radiologic examination and intervention.
Interpersonal
relationship
Disagreement ●The nurse at the ICU received the comments from a doctor unrelated to the care team for the indicated
patient and disagreed with the comment by stating that the doctor had no right to intervene the care for that
patient.
●The nurse reported that they did not need to perform the job they are not supposed to do, such as explain to
the patients about the operation procedure.
●The nurse reported that the way the indicated doctor spoke to the nurse was not acceptable.
Interference ●The doctor asked the staff to do more works that another discipline should do, which bothered the nurses.
●A doctor who was unrelated to the care team for the patient tried to put opinions into the patient care.
●The doctor unrelated to the Emergency Room and the patient care team asked the Emergency Room staff to
admit the patient to the ward.
Negative
emotion
●The nurse reported her staff members were very upset about the poor attitude and interaction from the
transferring unit.
●The lab technician stated the frustration and lack of respect during the contact with nurses for laboratory
sample issue.
●The doctor expressed his anger about the nurse repeatedly asked him to correct the medication order
without confirmation.
*Translated from the original Chinese texts.
doi:10.1371/journal.pone.0171696.t006
Table 7. Personnel involved and interpersonal relationship.
Worker job type Conflicts focused on the interpersonal relationship
Present (n = 41) Absent (n = 106) p-value
Reporter of the conflict in the incident
Doctor 14 (34.1%) 18 (17.0%) 0.0064
Nurse 14 (34.1%) 70 (66.0%)
Other healthcare professions 10 (24.4%) 14 (13.2%)
Supporting worker 3 (7.3%) 4 (3.8%)
Doctor reportedly involved in the conflict
Yes 27 (65.9%) 51 (48.1%) 0.053
No 14 (34.1%) 55 (51.9%)
doi:10.1371/journal.pone.0171696.t007
Workplace interpersonal conflicts and incident reporting system
PLOS ONE | DOI:10.1371/journal.pone.0171696 February 6, 2017 9 / 13
experience. Therefore the healthcare organization might need to pay attention to
ity of horizontal violence in workers with any level of working experience.
Because all of the WICs in this study focused on the task content or task process
the need for encouraging the conflict reporting for in the improvement of the proce
care. From the teamwork’s point of view, goal orientation moderates the relationsh
conflict and team performance [26]. Therefore, while the workers report conflicts,
have the mutual understanding on the goal of care, and communication undoubte
vital role in the management of conflicts. However, adequate communication is wa
since too much interaction might also contribute to misunderstanding because of p
words, body language, and expressions lead to intent [5]. For situations that effect
cation might not be feasible during the care process, reporting WICs focusing on ta
and task process through the IRS might be seen as a form of moderate way of com
to avoid more conflicts, as the reporter had perceived. Since many WICs also focus
interpersonal relationship, we also suggest that these types of reports should be d
internal informal complaint process [27]. Conflicts in the interpersonal relationship
atively affect patient care by interfering with one’s ability to work with the other m
health care team [28], especially when there is disruptive behavior [29]. In a surve
50% of healthcare workers witnessed the disruptive behaviors, and 18% reported t
aware of a particular adverse event that occurred as a direct result [30]. For a bett
environment, the organization should encourage the healthcare workers to report
The use of IRS as a channel for reporting interpersonal conflict might have the p
providing a chance to systemic improvement. Previous reports suggesting controv
clusions about the benefits of conflicts and performance and employee satisfaction
35]. The application of formal reporting system such as IRS might provide the chan
improve interpersonal conflicts. Management of the reported events are mainly ta
therefore might reduce the tension between the workers with interpersonal conflic
more on the goal of the task and the expected provided care.
Table 8. Personnel involved and negative emotion.
Worker type Negative emotion in the report
Present (n = 82) Absent (n = 65) p-value
Reporter of incidents
Doctor 23 (28.0%) 9 (13.8%) 0.125
Nurse 41 (50.0%) 43 (66.2%)
Other healthcare professions 13 (15.9%) 11 (16.9%)
Supporting worker 5 (6.1%) 2 (3.1%)
doi:10.1371/journal.pone.0171696.t008
Table 9. Workplace interpersonal conflicts and severities of incidents.
Severity Incidents without reported WIC (n = 8408) Incidents with reported WIC (n = 147) P value
According to event type
Near miss 1184 (14.1) 24 (16.3) <0.0001
No harm event 4660 (55.4) 107 (72.8)
Mild adverse event 2256 (26.8) 10 (6.8)
Moderate adverse event 270 (3.2) 5 (3.4)
Severe adverse event 20 (0.2) 0 (0)
Very severe adverse event 18 (0.2) 1 (0.7)
doi:10.1371/journal.pone.0171696.t009
Workplace interpersonal conflicts and incident reporting system
PLOS ONE | DOI:10.1371/journal.pone.0171696 February 6, 2017 10 / 13
ity of horizontal violence in workers with any level of working experience.
Because all of the WICs in this study focused on the task content or task process
the need for encouraging the conflict reporting for in the improvement of the proce
care. From the teamwork’s point of view, goal orientation moderates the relationsh
conflict and team performance [26]. Therefore, while the workers report conflicts,
have the mutual understanding on the goal of care, and communication undoubte
vital role in the management of conflicts. However, adequate communication is wa
since too much interaction might also contribute to misunderstanding because of p
words, body language, and expressions lead to intent [5]. For situations that effect
cation might not be feasible during the care process, reporting WICs focusing on ta
and task process through the IRS might be seen as a form of moderate way of com
to avoid more conflicts, as the reporter had perceived. Since many WICs also focus
interpersonal relationship, we also suggest that these types of reports should be d
internal informal complaint process [27]. Conflicts in the interpersonal relationship
atively affect patient care by interfering with one’s ability to work with the other m
health care team [28], especially when there is disruptive behavior [29]. In a surve
50% of healthcare workers witnessed the disruptive behaviors, and 18% reported t
aware of a particular adverse event that occurred as a direct result [30]. For a bett
environment, the organization should encourage the healthcare workers to report
The use of IRS as a channel for reporting interpersonal conflict might have the p
providing a chance to systemic improvement. Previous reports suggesting controv
clusions about the benefits of conflicts and performance and employee satisfaction
35]. The application of formal reporting system such as IRS might provide the chan
improve interpersonal conflicts. Management of the reported events are mainly ta
therefore might reduce the tension between the workers with interpersonal conflic
more on the goal of the task and the expected provided care.
Table 8. Personnel involved and negative emotion.
Worker type Negative emotion in the report
Present (n = 82) Absent (n = 65) p-value
Reporter of incidents
Doctor 23 (28.0%) 9 (13.8%) 0.125
Nurse 41 (50.0%) 43 (66.2%)
Other healthcare professions 13 (15.9%) 11 (16.9%)
Supporting worker 5 (6.1%) 2 (3.1%)
doi:10.1371/journal.pone.0171696.t008
Table 9. Workplace interpersonal conflicts and severities of incidents.
Severity Incidents without reported WIC (n = 8408) Incidents with reported WIC (n = 147) P value
According to event type
Near miss 1184 (14.1) 24 (16.3) <0.0001
No harm event 4660 (55.4) 107 (72.8)
Mild adverse event 2256 (26.8) 10 (6.8)
Moderate adverse event 270 (3.2) 5 (3.4)
Severe adverse event 20 (0.2) 0 (0)
Very severe adverse event 18 (0.2) 1 (0.7)
doi:10.1371/journal.pone.0171696.t009
Workplace interpersonal conflicts and incident reporting system
PLOS ONE | DOI:10.1371/journal.pone.0171696 February 6, 2017 10 / 13
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Our study has several limitations. First, since this study was retrospective and th
of this hospital did not provide a structured form for reporting WICs, we would miss
tion of WICs experienced by the healthcare workers who encountered the incident
also difficult to validate these WICs mainly based on the report contents; this was i
to the reports of incidents, which might be followed by further investigations as ind
ond, we did not know the presence of WICs during the patient care processes if the
incident reported. Although the establishment of a formal process for internal com
might be necessary, we believe that at least some of the WICs would be considere
jected for a formal reporting as complaints. Third, we did not investigate how the w
coped with WICs. Researchers had suggested a variety of types of behaviors for m
flicts in the context of “conflict management strategies” (i.e. a repertoire of reactio
flict that individuals may adopt depending on the situations) or “conflict managem
(implying a fixed tendency) [36]. Furthermore, approaches to managing conflict in
tions have been suggested [37]. Understand the conflict-managing behaviors of th
was beyond the scope of this study and might require other approaches in addition
dent report system here we used.
In conclusion, the institutional incident reporting system is a useful place to acti
the workplace interpersonal conflicts (WICs) related to task content and task proce
interpersonal relationship. The healthcare systems need to improve the channels t
cate, manage and resolve interpersonal conflicts.
Supporting information
S1 Dataset. Case File. The case data related to the workplace interpersonal con
from the incident reporting system of the institution.
(XLSX)
Acknowledgments
The authors would like to thank Chia-Shun Chang, M.D., Ph.D., Department of Inter
icine, National Taiwan University Hospital, Taipei, Taiwan, for his expertise on stati
ysis. We also thank Li-Hong Li and Yu-Tsu Li, Center for Quality Management, Natio
Taiwan University Hospital, Taipei, Taiwan, for their kind assistance in the preparat
reporting data.
Author contributions
Conceptualization: JSJ.
Data curation: JSJ SFH HWL.
Formal analysis: JSJ.
Investigation: JSJ LCC CKL HFH MYH.
Methodology: JSJ SFH HWL JSS.
Project administration: JSJ.
Resources: JSJ SFH HWL JSS.
Software: JSJ LCC.
Supervision: JSJ JSS.
Workplace interpersonal conflicts and incident reporting system
PLOS ONE | DOI:10.1371/journal.pone.0171696 February 6, 2017 11 / 13
of this hospital did not provide a structured form for reporting WICs, we would miss
tion of WICs experienced by the healthcare workers who encountered the incident
also difficult to validate these WICs mainly based on the report contents; this was i
to the reports of incidents, which might be followed by further investigations as ind
ond, we did not know the presence of WICs during the patient care processes if the
incident reported. Although the establishment of a formal process for internal com
might be necessary, we believe that at least some of the WICs would be considere
jected for a formal reporting as complaints. Third, we did not investigate how the w
coped with WICs. Researchers had suggested a variety of types of behaviors for m
flicts in the context of “conflict management strategies” (i.e. a repertoire of reactio
flict that individuals may adopt depending on the situations) or “conflict managem
(implying a fixed tendency) [36]. Furthermore, approaches to managing conflict in
tions have been suggested [37]. Understand the conflict-managing behaviors of th
was beyond the scope of this study and might require other approaches in addition
dent report system here we used.
In conclusion, the institutional incident reporting system is a useful place to acti
the workplace interpersonal conflicts (WICs) related to task content and task proce
interpersonal relationship. The healthcare systems need to improve the channels t
cate, manage and resolve interpersonal conflicts.
Supporting information
S1 Dataset. Case File. The case data related to the workplace interpersonal con
from the incident reporting system of the institution.
(XLSX)
Acknowledgments
The authors would like to thank Chia-Shun Chang, M.D., Ph.D., Department of Inter
icine, National Taiwan University Hospital, Taipei, Taiwan, for his expertise on stati
ysis. We also thank Li-Hong Li and Yu-Tsu Li, Center for Quality Management, Natio
Taiwan University Hospital, Taipei, Taiwan, for their kind assistance in the preparat
reporting data.
Author contributions
Conceptualization: JSJ.
Data curation: JSJ SFH HWL.
Formal analysis: JSJ.
Investigation: JSJ LCC CKL HFH MYH.
Methodology: JSJ SFH HWL JSS.
Project administration: JSJ.
Resources: JSJ SFH HWL JSS.
Software: JSJ LCC.
Supervision: JSJ JSS.
Workplace interpersonal conflicts and incident reporting system
PLOS ONE | DOI:10.1371/journal.pone.0171696 February 6, 2017 11 / 13
Validation: JSJ SFH HWL.
Visualization: JSJ JSS.
Writing – original draft: JSJ.
Writing – review & editing: JSJ JSS.
References
1. Marquis BL, Huston CJ. Leadership roles and management functions in nursing: Theory and applica-
tion: Lippincott Williams & Wilkins; 2009.
2. de Wit FR, Greer LL, Jehn KA. The paradox of intragroup conflict: a meta-analysis. Journal of Applied
Psychology. 2012; 97(2):360. doi: 10.1037/a0024844 PMID: 21842974
3. Jehn KA. A qualitative analysis of conflict types and dimensions in organizational groups. Administrative
Science Quarterly. 1997:530–57.
4. Barki H, Hartwick J. Conceptualizing the construct of interpersonal conflict. International Journal of Con-
flict Management. 2004; 15(3):216–44.
5. Wall JA, Callister RR. Conflict and its management. Journal of Management. 1995; 21(3):515–58.
6. Niiyama E, Okamura H, Kohama A, Taniguchi T, Sounohara M, Nagao M. A survey of nurses who
experienced trauma in the workplace: influence of coping strategies on traumatic stress. Stress and
Health. 2009; 25(1):3–9.
7. Guidroz AM, Wang M, Perez LM. Developing a Model of Source-specific Interpersonal Conflict in Health
Care. Stress and Health. 2012; 28(1):69–79. doi: 10.1002/smi.1405 PMID: 22259160
8. Fassier T, Azoulay E. Conflicts and communication gaps in the intensive care unit. Current Opinion in
Critical Care. 2010; 16(6):654–65. doi: 10.1097/MCC.0b013e32834044f0 PMID: 20930623
9. Katz JD. Conflict and its resolution in the operating room. Journal of Clinical Anesthesia. 2007; 19
(2):152–8. doi: 10.1016/j.jclinane.2006.07.007 PMID: 17379132
10. Chan T, Bakewell F, Orlich D, Sherbino J. Conflict Prevention, Conflict Mitigation, and Manifestations of
Conflict During Emergency Department Consultations. Academic Emergency Medicine. 2014; 21
(3):308–13. doi: 10.1111/acem.12325 PMID: 24628756
11. Lancman S, Maˆngia EF, Muramoto MT. Impact of conflict and violence on workers in a hospital emer-
gency room. Work: A Journal of Prevention, Assessment and Rehabilitation. 2013; 45(4):519–27.
12. Olson TJP, Brasel KJ, Redmann AJ, Alexander GC, Schwarze ML. Surgeon-reported conflict with
intensivists about postoperative goals of care. JAMA Surgery. 2013; 148(1):29–35. doi: 10.1001/
jamasurgery.2013.403 PMID: 23324837
13. Wright KB. A communication competence approach to healthcare worker conflict, job stress, job burn-
out, and job satisfaction. Journal for healthcare quality: official publication of the National Association for
Healthcare Quality. 2011; 33(2):7–14.
14. Schneider B, Gunnarson S. Organizational climate and culture: The psychology of the workplace.
Applying Psychology in Business Lexington, MA. 1991:542–51.
15. Mills MEC. Conflict in Health Care Organizations. J Health Care L & Pol’y. 2002; 5:502.
16. De Dreu CK, Weingart LR. Task versus relationship conflict, team performance, and team member sat-
isfaction: a meta-analysis. Journal of Applied Psychology. 2003; 88(4):741. PMID: 12940412
17. Baldwin DC Jr, Daugherty SR. Interprofessional conflict and medical errors: results of a national multi-
specialty survey of hospital residents in the US. Journal of Interprofessional Care. 2008; 22(6):573–86.
doi: 10.1080/13561820802364740 PMID: 19012138
18. Sari AB- A, Sheldon TA, Cracknell A, Turnbull A. Sensitivity of routine system for reporting patient safety
incidents in an NHS hospital: retrospective patient case note review. BMJ. 2007; 334(7584):79. doi: 10.
1136/bmj.39031.507153.AE PMID: 17175566
19. Fakhry SF, El Hassan NAA. Causes and types of conflict and resolution strategies among nursing stu-
dents: A comparative study between two cultures. Journal of American Science. 2011; 7(4):808–15.
20. Shaw R, Drever F, Hughes H, Osborn S, Williams S. Adverse events and near miss reporting in the
NHS. Quality and Safety in Health Care. 2005; 14(4):279–83. doi: 10.1136/qshc.2004.010553 PMID:
16076793
21. de Vries E, Ramrattan M, Smorenburg S, Gouma D, Boermeester M. The incidence and nature of in-
hospital adverse events: a systematic review. Qual Saf Health Care. 2008; 17:216–23. doi: 10.1136/
qshc.2007.023622 PMID: 18519629
Workplace interpersonal conflicts and incident reporting system
PLOS ONE | DOI:10.1371/journal.pone.0171696 February 6, 2017 12 / 13
Visualization: JSJ JSS.
Writing – original draft: JSJ.
Writing – review & editing: JSJ JSS.
References
1. Marquis BL, Huston CJ. Leadership roles and management functions in nursing: Theory and applica-
tion: Lippincott Williams & Wilkins; 2009.
2. de Wit FR, Greer LL, Jehn KA. The paradox of intragroup conflict: a meta-analysis. Journal of Applied
Psychology. 2012; 97(2):360. doi: 10.1037/a0024844 PMID: 21842974
3. Jehn KA. A qualitative analysis of conflict types and dimensions in organizational groups. Administrative
Science Quarterly. 1997:530–57.
4. Barki H, Hartwick J. Conceptualizing the construct of interpersonal conflict. International Journal of Con-
flict Management. 2004; 15(3):216–44.
5. Wall JA, Callister RR. Conflict and its management. Journal of Management. 1995; 21(3):515–58.
6. Niiyama E, Okamura H, Kohama A, Taniguchi T, Sounohara M, Nagao M. A survey of nurses who
experienced trauma in the workplace: influence of coping strategies on traumatic stress. Stress and
Health. 2009; 25(1):3–9.
7. Guidroz AM, Wang M, Perez LM. Developing a Model of Source-specific Interpersonal Conflict in Health
Care. Stress and Health. 2012; 28(1):69–79. doi: 10.1002/smi.1405 PMID: 22259160
8. Fassier T, Azoulay E. Conflicts and communication gaps in the intensive care unit. Current Opinion in
Critical Care. 2010; 16(6):654–65. doi: 10.1097/MCC.0b013e32834044f0 PMID: 20930623
9. Katz JD. Conflict and its resolution in the operating room. Journal of Clinical Anesthesia. 2007; 19
(2):152–8. doi: 10.1016/j.jclinane.2006.07.007 PMID: 17379132
10. Chan T, Bakewell F, Orlich D, Sherbino J. Conflict Prevention, Conflict Mitigation, and Manifestations of
Conflict During Emergency Department Consultations. Academic Emergency Medicine. 2014; 21
(3):308–13. doi: 10.1111/acem.12325 PMID: 24628756
11. Lancman S, Maˆngia EF, Muramoto MT. Impact of conflict and violence on workers in a hospital emer-
gency room. Work: A Journal of Prevention, Assessment and Rehabilitation. 2013; 45(4):519–27.
12. Olson TJP, Brasel KJ, Redmann AJ, Alexander GC, Schwarze ML. Surgeon-reported conflict with
intensivists about postoperative goals of care. JAMA Surgery. 2013; 148(1):29–35. doi: 10.1001/
jamasurgery.2013.403 PMID: 23324837
13. Wright KB. A communication competence approach to healthcare worker conflict, job stress, job burn-
out, and job satisfaction. Journal for healthcare quality: official publication of the National Association for
Healthcare Quality. 2011; 33(2):7–14.
14. Schneider B, Gunnarson S. Organizational climate and culture: The psychology of the workplace.
Applying Psychology in Business Lexington, MA. 1991:542–51.
15. Mills MEC. Conflict in Health Care Organizations. J Health Care L & Pol’y. 2002; 5:502.
16. De Dreu CK, Weingart LR. Task versus relationship conflict, team performance, and team member sat-
isfaction: a meta-analysis. Journal of Applied Psychology. 2003; 88(4):741. PMID: 12940412
17. Baldwin DC Jr, Daugherty SR. Interprofessional conflict and medical errors: results of a national multi-
specialty survey of hospital residents in the US. Journal of Interprofessional Care. 2008; 22(6):573–86.
doi: 10.1080/13561820802364740 PMID: 19012138
18. Sari AB- A, Sheldon TA, Cracknell A, Turnbull A. Sensitivity of routine system for reporting patient safety
incidents in an NHS hospital: retrospective patient case note review. BMJ. 2007; 334(7584):79. doi: 10.
1136/bmj.39031.507153.AE PMID: 17175566
19. Fakhry SF, El Hassan NAA. Causes and types of conflict and resolution strategies among nursing stu-
dents: A comparative study between two cultures. Journal of American Science. 2011; 7(4):808–15.
20. Shaw R, Drever F, Hughes H, Osborn S, Williams S. Adverse events and near miss reporting in the
NHS. Quality and Safety in Health Care. 2005; 14(4):279–83. doi: 10.1136/qshc.2004.010553 PMID:
16076793
21. de Vries E, Ramrattan M, Smorenburg S, Gouma D, Boermeester M. The incidence and nature of in-
hospital adverse events: a systematic review. Qual Saf Health Care. 2008; 17:216–23. doi: 10.1136/
qshc.2007.023622 PMID: 18519629
Workplace interpersonal conflicts and incident reporting system
PLOS ONE | DOI:10.1371/journal.pone.0171696 February 6, 2017 12 / 13
22. Runciman W, Hibbert P, Thomson R, Van Der Schaaf T, Sherman H, Lewalle P. Towards an Interna-
tional Classification for Patient Safety: key concepts and terms. International Journal for Quality in
Health Care. 2009; 21(1):18–26. doi: 10.1093/intqhc/mzn057 PMID: 19147597
23. Leung K, Koch PT, Lu L. A dualistic model of harmony and its implications for conflict management in
Asia. Asia Pacific Journal of Management. 2002; 19(2–3):201–20.
24. Tjosvold D, Poon M, Yu Z-y. Team effectiveness in China: Cooperative conflict for relationship building.
Human Relations. 2005; 58(3):341–67.
25. McKenna BG, Smith NA, Poole SJ, Coverdale JH. Horizontal violence: experiences of registered
nurses in their first year of practice. Journal of Advanced Nursing. 2003; 42(1):90–6. PMID: 12641816
26. Huang J-C. The relationship between conflict and team performance in Taiwan: the moderating effect
of goal orientation. The International Journal of Human Resource Management. 2012; 23(10):2126–43.
27. Pietroni P, de Uray-Ura S. Informal complaints procedure in general practice: first year’s experience.
BMJ. 1994; 308(6943):1546–9. PMID: 8019313
28. Association AM. Report of the Council on Ethical and Judicial Affairs. Physicians With Disruptive Behav-
ior. Chicago, IL: American Medical Association; 2009.
29. Walrath JM, Dang D, Nyberg D. An organizational assessment of disruptive clinician behavior: findings
and implications. Journal of Nursing Care Quality. 2013; 28(2):110–21. doi: 10.1097/NCQ.
0b013e318270d2ba PMID: 23072933
30. Rosenstein AH, Naylor B. Incidence and impact of physician and nurse disruptive behaviors in the
emergency department. The Journal of Emergency Medicine. 2012; 43(1):139–48. doi: 10.1016/j.
jemermed.2011.01.019 PMID: 21421291
31. Greer LL, Saygi O, Aaldering H, de Dreu CK. Conflict in medical teams: opportunity or danger? Medical
Education. 2012; 46(10):935–42. doi: 10.1111/j.1365-2923.2012.04321.x PMID: 22989127
32. Jehn KA. A multimethod examination of the benefits and detriments of intragroup conflict. Administra-
tive Science Quarterly. 1995:256–82.
33. Solansky ST, Singh B, Huang S. Individual Perceptions of Task Conflict and Relationship Conflict.
Negotiation and Conflict Management Research. 2014; 7(2):83–98.
34. Kaitelidou D, Kontogianni A, Galanis P, Siskou O, Mallidou A, Pavlakis A, et al. Conflict management
and job satisfaction in paediatric hospitals in Greece. Journal of Nursing Management. 2012; 20
(4):571–8. doi: 10.1111/j.1365-2834.2011.01196.x PMID: 22591158
35. Moye NA, Langfred CW. Information sharing and group conflict: Going beyond decision making to
understand the effects of information sharing on group performance. International Journal of Conflict
Management. 2004; 15(4):381–410.
36. Nguyen H-HD, Yang J. Chinese employees’ interpersonal conflict management strategies. International
Journal of Conflict Management. 2012; 23(4):382–412.
37. Gross MA, Hogler R, Henle CA. Process, people, and conflict management in organizations: A view-
point based on Weber’s formal and substantive rationality. International Journal of Conflict Manage-
ment. 2013; 24(1):90–103.
Workplace interpersonal conflicts and incident reporting system
PLOS ONE | DOI:10.1371/journal.pone.0171696 February 6, 2017 13 / 13
tional Classification for Patient Safety: key concepts and terms. International Journal for Quality in
Health Care. 2009; 21(1):18–26. doi: 10.1093/intqhc/mzn057 PMID: 19147597
23. Leung K, Koch PT, Lu L. A dualistic model of harmony and its implications for conflict management in
Asia. Asia Pacific Journal of Management. 2002; 19(2–3):201–20.
24. Tjosvold D, Poon M, Yu Z-y. Team effectiveness in China: Cooperative conflict for relationship building.
Human Relations. 2005; 58(3):341–67.
25. McKenna BG, Smith NA, Poole SJ, Coverdale JH. Horizontal violence: experiences of registered
nurses in their first year of practice. Journal of Advanced Nursing. 2003; 42(1):90–6. PMID: 12641816
26. Huang J-C. The relationship between conflict and team performance in Taiwan: the moderating effect
of goal orientation. The International Journal of Human Resource Management. 2012; 23(10):2126–43.
27. Pietroni P, de Uray-Ura S. Informal complaints procedure in general practice: first year’s experience.
BMJ. 1994; 308(6943):1546–9. PMID: 8019313
28. Association AM. Report of the Council on Ethical and Judicial Affairs. Physicians With Disruptive Behav-
ior. Chicago, IL: American Medical Association; 2009.
29. Walrath JM, Dang D, Nyberg D. An organizational assessment of disruptive clinician behavior: findings
and implications. Journal of Nursing Care Quality. 2013; 28(2):110–21. doi: 10.1097/NCQ.
0b013e318270d2ba PMID: 23072933
30. Rosenstein AH, Naylor B. Incidence and impact of physician and nurse disruptive behaviors in the
emergency department. The Journal of Emergency Medicine. 2012; 43(1):139–48. doi: 10.1016/j.
jemermed.2011.01.019 PMID: 21421291
31. Greer LL, Saygi O, Aaldering H, de Dreu CK. Conflict in medical teams: opportunity or danger? Medical
Education. 2012; 46(10):935–42. doi: 10.1111/j.1365-2923.2012.04321.x PMID: 22989127
32. Jehn KA. A multimethod examination of the benefits and detriments of intragroup conflict. Administra-
tive Science Quarterly. 1995:256–82.
33. Solansky ST, Singh B, Huang S. Individual Perceptions of Task Conflict and Relationship Conflict.
Negotiation and Conflict Management Research. 2014; 7(2):83–98.
34. Kaitelidou D, Kontogianni A, Galanis P, Siskou O, Mallidou A, Pavlakis A, et al. Conflict management
and job satisfaction in paediatric hospitals in Greece. Journal of Nursing Management. 2012; 20
(4):571–8. doi: 10.1111/j.1365-2834.2011.01196.x PMID: 22591158
35. Moye NA, Langfred CW. Information sharing and group conflict: Going beyond decision making to
understand the effects of information sharing on group performance. International Journal of Conflict
Management. 2004; 15(4):381–410.
36. Nguyen H-HD, Yang J. Chinese employees’ interpersonal conflict management strategies. International
Journal of Conflict Management. 2012; 23(4):382–412.
37. Gross MA, Hogler R, Henle CA. Process, people, and conflict management in organizations: A view-
point based on Weber’s formal and substantive rationality. International Journal of Conflict Manage-
ment. 2013; 24(1):90–103.
Workplace interpersonal conflicts and incident reporting system
PLOS ONE | DOI:10.1371/journal.pone.0171696 February 6, 2017 13 / 13
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