Biting the hand that heals: mistreatment by patients and the well-being of healthcare workers
| Pages | 572-591 |
| Published date | 05 March 2018 |
| DOI | https://doi.org/10.1108/PR-03-2016-0054 |
| Date | 05 March 2018 |
| Author | Aysegul Karaeminogullari,Berrin Erdogan,Talya N. Bauer |
| Subject Matter | HR & organizational behaviour,Global HRM |
Biting the hand that heals:
mistreatment by patients and the
well-being of healthcare workers
Aysegul Karaeminogullari, Berrin Erdogan and Talya N. Bauer
School of Business Administration,
Portland State University, Portland, Oregon, USA
Abstract
Purpose –The purpose of this paper is to explore the relationship between stress due to mistreatment
by patients and caregivers’own well-being indicators (anxiety, depression, and behavioral stress
indicators). Based on predictions consistent with the job demands-resources model, it is anticipated that
satisfaction with job resources would moderate the relationship between mistreatment by patients and
well-being indicators.
Design/methodology/approach –Hypotheses were tested with a sample of 182 employees in a leading
training and research university hospital in Istanbul, Turkey. Results were partially replicated for a separate
sample of 122 healthcare workers. Data were collected using the survey methodology.
Findings –The findings suggest tha t patient injustice is positively relate dt o depression and behavioral
stress indicators whe n satisfaction with job re sources is high. Result s illustrate that satis faction with
job resources has a sensit izing, rather than a buf fering, role on the rela tion between mistrea tment by
patients, depressio n, and behavioral stress indicators , negatively affecting employees wit h higher levels of
satisfaction with job re sources.
Originality/value –Organizational justice researchers recently started recognizing that in addition to
organizational insiders, organizational outsiders such as customers and patients may also be sources of fair
and unfair treatment. Based on this stream of research, unfair treatment from outsiders is associated with
retaliation and a variety of negative employee outcomes. The study extends the currently accumulated work
by examining how mistreatment from care recipients relates to healthcare workers’own health outcomes.
Keywords Quantitative, Healthcare, Well-being, Job demands-resources model, Mistreatment by patients
Paper type Research paper
Introduction
Employee perceptions of interactional fairness have received considerable attention in
theacademicliterature(e.g.Colquittet al., 2001). Generally, researchers have established
that employees perceive fair interactions when they are treated with dignity and respect
(Bies and Moag, 1986) whereas they perceive unfairness and mistreatment in cases of
undeserved prejudicial statements (Rupp and Spencer, 2006) or hurtful personal attacks
(Bies and Moag, 1986). Until recently, intra-organizational sources of unfairness,
including the organization, supervisors, and coworkers, have been within the scope of
investigations (e.g. Cropanzano et al., 2002; Folger and Konovsky, 1989).
However, scholars have begun to examine a relatively new source of interactional
mistreatment –external parties such as customers, guests, or patients of an organization
(Ho and Gupta, 2014; Rupp and Spencer, 2006).
A perplexing reality is that even employees who dedicate their careers to helping the
health and well-being of others such as nurses (Speroni et al., 2014), emergency department
workers (Gates et al., 2006), and firefighters (Sliter and Boyd, 2015) are often targets of
unfair, rude, disrespectful, and sometimes violent treatment. In an extreme example,
relatives of a patient who died during treatment attacked a doctor in India, resulting in an
indefinite strike by medical personnel (Deccan Herald, 2016). The problem is not limited to a
few isolated cases. In a countywide report of Los Angeles, general and mental healthcare
workers, in comparison with other employee groups, have reported higher rates of
Personnel Review
Vol. 47 No. 2, 2018
pp. 572-591
© Emerald PublishingLimited
0048-3486
DOI 10.1108/PR-03-2016-0054
Received 15 March 2016
Revised 6 February 2017
24 August 2017
Accepted 30 August 2017
The current issue and full text archive of this journal is available on Emerald Insight at:
www.emeraldinsight.com/0048-3486.htm
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PR
47,2
workplace assaults (Sullivan and Yuan, 1995). A cross-sectional study of employees in a
Midwest healthcare organization showed that nearly 31 percent of employees reported
experiencing non-physical aggression (Findorff et al., 2004).
Given this prevalence, stress caused by mistreatment from customers and care recipients has
the potential to result in undesirable employee outcomes, making it a critically important topic of
study. To date, scholars have typically focused on how employees retaliate against customers or
how job attitudes fluctuate when they experience customer mistreatment (e.g. Shao and
Skarlicki, 2014; Skarlicki et al., 2008). What is rare in this stream of research are studies
exploring how mistreatment by the people one is serving affects one’s own health and
well-being. Referring to this research gap, our aim in this study is to explore two key questions:
RQ1. What is the relationship between stress due to patient mistreatment and
employees’physical and mental well-being?
RQ2. What are the factors that could ameliorate the negative effects of mistreatment by
patients?
Hence, we conducted two independent studies to test the effects of mistreatment by patients
on three indicators (anxiety, depression, and behavioral stress indicators) of employee
well-being. In study 1, we operationalized mistreatment by patients as perceived stress due
to patients, and in study 2, as interpersonal injustice attributable to patients.
In these two studies together, we test a model linking unfair treatment from patients and
caregiver well-being (e.g. anxiety, depression, and behavioral stress indicators) while
investigating the moderating role of job resources. The first contribution of this study is to
expand the existing literature on customer mistreatment by examining caregiver well-being
as an outcome of stress due to patient mistreatment. De Lange et al. (2005) document that
stressful work diminishes psychological and physical well-being. Estimations of a Gallup
poll suggest that the cost of lost productivity due to unhealthy workers is $153 billion a year
(Ciccone, 2011). Thus, employee health is a critically important outcome for employees and
their organizations, as well as the society at large.
Second, while scholars have investigated the direct effects of customer injustice and
mistreatmenton negative emotional states,less is known about potential boundaryconditions
of these relationships. Caregiving occupations have a high riskof mistreatment (LeBlanc and
Kelloway, 2002),but jobs in this sector may also provideresources that potentiallystrengthen
and empower the employee. Based on the job demands-resources ( JD-R) model (Bakker and
Demerouti, 2007; Demerouti et al., 2001), aspects of the work environment that are functional
in helping achieve work goals, stimulate learning, or otherwise reduce demands of one’sjob
interact with job demands to predict stress and outcomes. Consistent with this model, we
examine how satisfaction with specific job resources may affect the relationship between
stress arising from patient injustice, mental health, and unhealthy behaviors.
Finally, our third contribution is our examination of the proposed model in two samples
of Turkish healthcare workers who provide service in a setting with high levels of
interpersonal tension (Maslach and Jackson, 1984; Vredenburgh et al., 1999). While customer
orientation in service-providing occupations creates a power inequality between customers
and service providers (Grandey et al., 2004), patients’vulnerability and dependency on the
caregiver are mitigating factors in the case of healthcare setting, making healthcare workers
a unique population to study. Due to the growing body of verbal and physical abuse reports
in daily press and descriptive research that puts forth the extensiveness of the problem
(Kisa, 2008), more empirical studies are needed in this unique context.
In summary, this current study attempts to provide three contributions to the literature.
First, we aim to extend the existing knowledge on the outcomes of stress caused by outsider
injustice by focusing on mental health problems and risky health behaviors as potential
outcomes. Second, we attempt to make a contribution by examining whether job-related
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Biting the
hand that heals
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