Workplace interpersonal conflicts among healthcare workers: Retrospective exploration from the institutional incident reporting system of a university-affiliated medical center

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
* [e-mail]
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
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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.

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 nomenclature
exists, such as task, process, information, emotional and relationship conflicts [2–4]. This kind
of conflict is often regarded as a negative term because individual interests are perceived to be
opposed or negatively affected [5]. Recently, there have been concerns about workplace inter-
personal conflict (WIC) and its impact on the healthcare system and the workers [6]. A variety
of individuals, including doctors, nurses, co-workers, managers and administrative workers
might have experienced conflicts [7]. The WICs were also commonly encountered in intensive
care units [8], operating rooms [9] and emergency rooms [10, 11]. These high-risk health care
areas often require intensive patient caring, timely decision-making, and multidisciplinary
coordination among the workers [12]. WICs might be the consequence of poor communica-
tion [13], excessive work stress [14] or unsolved competing priorities of tasks [15]. Once devel-
oped, the WIC might, in turn, possess deleterious effects on the workers, such as interference
with the team performance and reduction of staff satisfaction [16]. Furthermore, reports have
associated WICs with lower-quality patient care, higher rates of medical errors, a higher level
of staff burnout, and greater direct and indirect costs of care [17].
Since these consequences might compromise patient safety, we proposed that the workers
of the healthcare system might report interpersonal conflicts in the process of patient care
when they report patient safety events. Many healthcare systems worldwide have implemented
the incident reporting system (IRS) to understand the occurrence of patient safety events [18].
Since 2000, our institution has established an IRS for the workers in the hospital to report
safety-related events in the hospital. Previous reports of the studies on the WIC in the health-
care settings applied mainly questionnaire investigations and surveys [12, 19] while real-life
case-specific descriptions of the WIC were lacking, probably because reporting directly from
the workers might require an adequate channel. Whether or no the IRS might also be a possi-
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 (NTUH)
to analyze the collected data from the incident reporting system (IRS) of the institution from
July 2010 to June 2013. The Research Ethical Committee A of the National Taiwan University
Hospital approved the study and exempted the informed consents.
The NTUH was a 2,300-bed, university-affiliated medical center, containing about 6,400
full-time employees, which included more than 1,000 doctors and 2,700 nurses. In 2000, the
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 operated through
a paper-based reporting process, and then adopted on-line reporting mechanism in 2005 by
integrating into the hospital’s intranet. The reporting of the safety incident was voluntary and
non-punitive, focused on safety-related events or concerns to the patients, workers and visi-
tors. In addition to structured checkboxes for data entry, the online page also provided a free
text field for the reporter to describe the events. After the reporting, the Center for Quality
Management managed the data. The staff of this centralized unit of this institution verified the
incidents, collected and analyzed pertinent information, performed important discussions
with the workers from where the events occurred, and participated in the improvement
activities.
The definition and severity of the safety-related incidents were classified as previously
described in the literature [20–22]. Briefly, a safety incident or event is an unexpected or unin-
tended event, which could have led to or did result in harm of the involved person. An adverse
event was an injury caused during the health care process rather than by the underlying disease
or condition of the individual. A no-harm event was an event, which resulted in no harm to
the person, or the effect was minor that the individual could not even feel it. A near miss event
was an event that may cause accident, injury or illness, but did not happen because of uninten-
tional or timely intervention [20–22]. We excluded the reports from the database of IRS if the
incidents were not related to any health care or service process for the patients, or not relevant
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 Institution’s Center
for Quality Management reviewed all available incident reports. All team members had at
least one year’s training in the process. Four of the seven reviewers independently selected the
reports they considered to contain the descriptions compatible with workforce conflict and
recorded the type using the classification in Table 1 below. The three other members then par-
ticipated in the assessment of selected reports and authenticated the consensus results. Records
were de-identified and analyzed anonymously.
Interpersonal conflict
We classified workplace conflicts using a modified Barki and Hartwick typology based scheme
[4] (Table 1). We defined interpersonal conflict as “a dynamic process that occurs between
interdependent individuals, groups, or both, as they experience negative emotional reactions
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.” The two types
of focus of the interpersonal conflict identified included the conflicts related to task content or
process, and the conflicts related to the interpersonal relationship. We explored each for dis-
agreement, interference, and negative emotion as the property of the WICs. Disagreement
reflects cognitive difference based on a divergence of values, needs, interests, opinions, or
goals. Interference indicates conflict due to behavioral difference and used by one party to
interfere with or oppose another party’s attaining its interests, objectives or goals. Such be-
haviors include debate, argumentation, competition, political maneuvering, backstabbing,
aggression, hostility, and destruction. Negative emotions produce conflict and underlie fear,
jealousy, anger, anxiety, and frustrations [4]. Table 1 depicts the typology of the classification
of WICs used throughout this study. In each incident, the investigators identified at least one
focus and property of conflict. Based on the text descriptions from the reporters and consensus
after discussions, the investigators classified the incident-related processes that were related to
the WICs and then identified the tasks that were considered most closely related to the occur-
rence of WICs.
Collection of data
The investigators collected the following data for analysis: dates, times, place, and departments
where the incidents and conflicts occurred, types and categories of the reported incidents, job
types of the reporting workers and employees involved in the WIP, and working experience of
the reporting workers. Records were de-identified and analyzed anonymously. We also
included the data regarding the types of the conflicts into analysis together with the collected
data.
Statistical analysis
We first analyzed the health care characteristics relating to the development of WICs found in
the reported incidents, such as health care related processes, worker types involved in the
development of WIP, and severity of the reported incidents. We then described the typing of
the WICs, based on the focus of the conflicts. We then further explore the possible association
of job scenario and the development of WIP by comparing different characteristics among
groups.
Results are summarized and expressed as counts and percentage for nominal variables, or
median with range for ages. The chi-square test was used to compare across different catego-
ries, such as incident types, job types of the workers. The Mann-Whitney U-test was used to
compare the age between groups of workers. Statistical analysis was performed using the SPSS
22 Software (SPSS Corp., Chicago, IL, USA). A P<0.05 was considered statistically significant.
Results
During the 3-year study period, a total of 8,555 safety-related incidents (Table 2) were reported
hospital-wide, with an average of 237 events every month. Among the 8,555 safety-related inci-
dents, 147 (1.7%) had WIC. Strikingly none involved fall events and tubing/line events, and
few involved medication. 96% involved health care or service processes (Table 3). Most com-
monly, they involved the transfer of patients between units or departments (20%), laboratory
tests (17%), surgery (16%) and medical image examination and interventions (16%). For each
category of the incident-related processes, the first tasks were the most frequent (64 incidents,
44%) in these processes associated with the conflict, such as the decision to start the process,
the requesting for the care process and the scheduling for the process. (Table 3).
Workplace interpersonal conflicts and incident reporting system
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