Bulwark Effect of Response in a Causal Model of Disruptive Clinician Behavior: A Quantitative Analysis of the Prevalence and Impact in Japanese General Hospitals

Abstract

Background: Disruptive clinician behavior (DCB) negatively affects patient safety by impairing healthcare team communication. In Japanese hospitals, hierarchical structures and traditional leadership styles contribute to its persistence. This study examines the prevalence and impact of DCB in two general hospitals and evaluates the role of response strategies in mitigating its effects. Methods: A quantitative web-based survey was conducted among 256 healthcare professionals from two general hospitals (751 and 661 beds). The survey included demographic data, a validated DCB scale, and a structured questionnaire assessing triggers, responses, and impacts. Statistical analyses included principal component analysis (PCA), structural equation modeling (SEM), and moderated mediation analysis. Results: Among participants, 79.3% reported experiencing or witnessing DCB. Psychological/social impact partially mediated the relationship between DCB and hospital management issues (β = 0.19, p = 0.001). Response strategies reduced the psychological/social impact of DCB (β = −0.20, p < 0.001) but did not mitigate its direct effect on hospital management. Conclusions: While prompt responses can alleviate the psychological burden on victims, they do not prevent broader institutional damage caused by DCB. Effective interventions should focus on both individual and organizational measures to reduce the occurrence of DCB.