Individual, interpersonal, and organisational factors of healthcare conflict: A scoping review

Unresolved conflicts among healthcare professionals can lead to difficult patient care consequences. This scoping review examines the current healthcare literature that reported sources and consequences of conflict associated with individual, interpersonal, and organisational factors. We identified 99 articles published between 2001 and 2015 from PubMed, Cumulative Index to Nursing and Allied Health Literature, and Excerpta Medical Database. Most reviewed studies relied on healthcare professionals’ perceptions and beliefs associated with conflict sources and consequences, with few studies reporting behavioural or organisational change outcomes. Individual conflict sources included personal traits, such as self-focus, self-esteem, or worldview, as well as individuals’ conflict management styles. These conflicts posed threats to one’s physical, mental, and emotional health and to one’s ability to perform at work. Interpersonal dynamics were hampered by colleagues’ uncivil behaviours, such as low degree of support, to more destructive behaviours including bullying or humiliation. Perceptions of disrespectful working environment and weakened team collaboration were the main interpersonal conflict consequences. Organisational conflict sources included ambiguity in professional roles, scope of practice, reporting structure, or workflows, negatively affecting healthcare professionals’ job satisfactions and intent to stay. Future inquiries into healthcare conflict research may target the following: shifting from research involving single professions to multiple professions; dissemination of studies via journals that promote interprofessional research; inquiries into the roles of unconscious or implicit bias, or psychological capital (i.e., resilience) in healthcare conflict; and diversification of data sources to include hospital or clinic data with implications for conflict sources.

医护人员间未能化解的冲突，会给患者照护工作带来不利后果。本次范围综述（scoping review）旨在系统梳理当前医疗健康领域的相关文献，这些文献聚焦于与个体、人际及组织层面因素相关的冲突来源与后果。我们从PubMed数据库、护理及相关健康文献累积索引（Cumulative Index to Nursing and Allied Health Literature）以及医学文摘数据库（Excerpta Medical Database）中，筛选得到2001年至2015年间发表的99篇文献。纳入本次综述的绝大多数研究，均基于医护人员对冲突来源与后果的认知与看法，仅有少数研究报告了行为层面或组织层面的变革结果。个体层面的冲突来源包括个人特质（如自我中心、自尊水平或世界观），以及个体的冲突管理风格。此类冲突会对医护人员的躯体、心理及情绪健康，以及职场履职能力造成威胁。同事间的不文明行为（如支持度不足）乃至更具破坏性的霸凌、羞辱行为，会破坏人际互动关系。医护人员感知到的工作环境缺乏尊重，以及团队协作能力削弱，是人际层面冲突的主要后果。组织层面的冲突来源包括专业角色、执业范围、汇报架构及工作流程界定模糊，这类情况会降低医护人员的工作满意度与留任意愿。未来医疗健康领域冲突相关研究可聚焦以下方向：从单一职业群体研究转向多职业群体研究；通过倡导跨专业研究的期刊传播相关研究成果；探究无意识或内隐偏见、心理资本（psychological capital，即韧性）在医疗冲突中的作用；以及拓展数据来源维度，纳入可反映冲突来源的医院或门诊数据。