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'Broken hospital windows': debating the theory of spreading disorder and its application to healthcare organizations.
BMC Health Serv Res. 2018 03 22; 18(1):201.BH

Abstract

BACKGROUND

Research in criminology and social-psychology supports the idea that visible signs of disorder, both physical and social, may perpetuate further disorder, leading to neighborhood incivilities, petty violations, and potentially criminal behavior. This theory of 'broken windows' has now also been applied to more enclosed environments, such as organizations.

MAIN TEXT

This paper debates whether the premise of broken windows theory, and the concept of 'disorder', might also have utility in the context of health services. There is already a body of work on system migration, which suggests a role for violations and workarounds in normalizing unwarranted deviations from safe practices in healthcare organizations. Studies of visible disorder may be needed in healthcare, where the risks of norm violations and disorderly environments, and potential for harm to patients, are considerable. Everyday adjustments and flexibility is mostly beneficial, but in this paper, we ask: how might deviations from the norm escalate from necessary workarounds to risky violations in care settings? Does physical or social disorder in healthcare contexts perpetuate further disorder, leading to downstream effects, including increased risk of harm to patients?

CONCLUSIONS

We advance a model of broken windows in healthcare, and a proposal to study this phenomenon.

Authors+Show Affiliations

Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, 2109, Australia. kate.churruca@mq.edu.au.Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, 2109, Australia.Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, 2109, Australia.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29566697

Citation

Churruca, Kate, et al. "'Broken Hospital Windows': Debating the Theory of Spreading Disorder and Its Application to Healthcare Organizations." BMC Health Services Research, vol. 18, no. 1, 2018, p. 201.
Churruca K, Ellis LA, Braithwaite J. 'Broken hospital windows': debating the theory of spreading disorder and its application to healthcare organizations. BMC Health Serv Res. 2018;18(1):201.
Churruca, K., Ellis, L. A., & Braithwaite, J. (2018). 'Broken hospital windows': debating the theory of spreading disorder and its application to healthcare organizations. BMC Health Services Research, 18(1), 201. https://doi.org/10.1186/s12913-018-3012-2
Churruca K, Ellis LA, Braithwaite J. 'Broken Hospital Windows': Debating the Theory of Spreading Disorder and Its Application to Healthcare Organizations. BMC Health Serv Res. 2018 03 22;18(1):201. PubMed PMID: 29566697.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 'Broken hospital windows': debating the theory of spreading disorder and its application to healthcare organizations. AU - Churruca,Kate, AU - Ellis,Louise A, AU - Braithwaite,Jeffrey, Y1 - 2018/03/22/ PY - 2017/05/10/received PY - 2018/03/15/accepted PY - 2018/3/24/entrez PY - 2018/3/24/pubmed PY - 2018/8/30/medline KW - Broken windows theory KW - Harm KW - Healthcare KW - Hospitals KW - Organizational theory KW - Patient safety KW - Quality of care KW - Violations SP - 201 EP - 201 JF - BMC health services research JO - BMC Health Serv Res VL - 18 IS - 1 N2 - BACKGROUND: Research in criminology and social-psychology supports the idea that visible signs of disorder, both physical and social, may perpetuate further disorder, leading to neighborhood incivilities, petty violations, and potentially criminal behavior. This theory of 'broken windows' has now also been applied to more enclosed environments, such as organizations. MAIN TEXT: This paper debates whether the premise of broken windows theory, and the concept of 'disorder', might also have utility in the context of health services. There is already a body of work on system migration, which suggests a role for violations and workarounds in normalizing unwarranted deviations from safe practices in healthcare organizations. Studies of visible disorder may be needed in healthcare, where the risks of norm violations and disorderly environments, and potential for harm to patients, are considerable. Everyday adjustments and flexibility is mostly beneficial, but in this paper, we ask: how might deviations from the norm escalate from necessary workarounds to risky violations in care settings? Does physical or social disorder in healthcare contexts perpetuate further disorder, leading to downstream effects, including increased risk of harm to patients? CONCLUSIONS: We advance a model of broken windows in healthcare, and a proposal to study this phenomenon. SN - 1472-6963 UR - https://www.unboundmedicine.com/medline/citation/29566697/'Broken_hospital_windows':_debating_the_theory_of_spreading_disorder_and_its_application_to_healthcare_organizations L2 - https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-3012-2 DB - PRIME DP - Unbound Medicine ER -