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In response to the growing evidence that disruptive behaviors within health care teams constitute a major threat to the quality of care, the Joint Commission on Accreditation of Healthcare Organization (JCAHO; Joint Commission Resources, 2008) has a new leadership standard that addresses disruptive and inappropriate behaviors effective January 1, 2009. For professionals who work in human resources and organization development, these standards represent a clarion call to design and implement evidence-based interventions to create health care communities of respectful engagement that have zero tolerance for disruptive, uncivil, and intimidating behaviors by any professional. In this chapter, we will build an evidence-based argument that sustainable change must include organizational, team, and individual strategies across all professionals in the organization. We will then describe an intervention model – Toxic Organization Change System – that has emerged from our own research on toxic behaviors in the workplace (Kusy & Holloway, 2009) and provide examples of specific strategies that we have used to prevent and ameliorate toxic cultures.

Incivility is widespread in the workplace and has been shown to have significant affective and behavioral consequences. However, the authors still have a limited understanding as to whether, how and when discrete incivility events impact team performance. Adopting a resource depletion perspective and focusing on the cognitive implications of such events, the authors introduce a multi-level model linking the adverse effects of such events on team members’ working memory – the “workbench” of the cognitive system where most planning, analyses, and management of goals occur – to team effectiveness. The model which the authors develop proposes that that uncivil interpersonal behavior in general, and rudeness – a central manifestation of incivility – in particular, may place a significant drain on individuals’ working memory capacity, affecting team effectiveness via its effects on individual performance and coordination-related team emergent states and action-phase processes. In the context of this model, the authors offer an overarching framework for making sense of disparate findings regarding how, why and when incivility affects performance outcomes at multiple levels. More specifically, the authors use this framework to: (a) suggest how individual-level cognitive impairment and weakened coordinative team processes may mediate these incivility-based effects, and (b) explain how event, context, and individual difference factors moderators may attenuate or exacerbate these cognition-mediated effects.

This chapter examines group communication in medical teams through psychological safety and simulation training research. Research has shown that medical teams are challenged by established hierarchies, power/status differences, temporal stability, changing team memberships, and deeply held beliefs that emphasize individual responsibility. A review of 47 studies (29 psychological safety, 18 simulation) was conducted to understand key findings in relationship to group communication. Results indicate that team leadership promotes team psychological safety, voice, and relationship quality while status differences and hierarchy continue to affect psychological safety within medical teams. Simulation training facilitated interprofessional relationships, attitudes toward teamwork, self-efficacy, and group communication. The findings of this review suggest that psychological safety may be developed through simulation training. The quality of patient care is improved when all members of medical teams have the ability and motivation to communicate effectively.

In emergency departments, effective communication is of utmost importance to ensure the safety of patients. However, communicating can be quite challenging when dealing with high-stress situations. This study aims to assess the efficacy of coaching workshops, informed by a transtheoretical coaching model, in managing communication challenges perceived by emergency nurses and enhancing their communication skills.

The study involved seven emergency room nurses working at a public hospital in Morocco. The data were gathered through various instruments, including observation grids, interviews and pre- and post-test questionnaires.

The study identified prevalent challenges in communication among nurses, notably difficulties in accurately interpreting messages when faced with confrontational attitudes from colleagues or superiors. Additionally, some nurses exhibited asymmetrical communication patterns, prioritizing their own perspectives over others' during interactions. The findings revealed a statistically significant disparity between pre- and post-test scores (P = 0.017). The nurses’ mean score has improved by 5.14 after attending the four workshop coaching experience, passing from 5.71 in the pre-test to 10.85 in the post-test.

This is the first study in Morocco to evaluate the effectiveness of coaching workshops guided by a transtheoretical coaching model in improving communication skills and overcoming communication barriers among working emergency nurses.

In the USA, there has recently been an unprecedented convergence of complementary/alternative medicine (CAM) with mainstream biomedical care. This confluence may lead to a deeply rooted philosophical conflict. This qualitative study works to identify factors that health-care leaders can use, which will build a pathway to greater integrative practice between medical doctors and CAM practitioners – from parallel existence to partnership – by examining the tensions between biomedical medicine and naturopathic medicine. The purpose of this study is to offer short-term suggestions for partnership and long-term recommendations for better understanding.

An original qualitative study using semi-structured with CAM practitioners and biomedical practitioners.

Areas of conflict that are preventing synergy are identified and a pathway for health-care leaders to follow to create greater integration and partnerships is suggested.

This is a qualitative and exploratory study that has significant limitations on generalizability.

This study suggest steps that both types of health-care practitioners can take to increase their success at working together on an individual level, a group level, an organizational level and on an industry-wide basis, as well as provide a specific pathway to create greater integrative practice for health-care leaders.

The results indicate that stronger partnerships between different types of medical practitioners increase patient choice, patient satisfaction and outcomes.

Increasing interested in CAM modalities is driving more contact between CAM practitioners and biomedical practitioners. This contact is best established in partnership between practitioners rather than in parallel. This original research outlines the sources of conflict and provides recommendations for encouraging greater synergy.

The purpose of this study is to empirically test a hierarchical model of the antecedents of nurse job satisfaction and loyalty based on the internal marketing literature. Specifically, the study aims to investigate the degree to which structural, social, and financial bonding activities influence nurses' job satisfaction and retention.

Following a review of the literature, the model was tested via a survey of 200 nurses from three US health care institutions.

The study resulted in key findings pertaining to the hierarchical nature of structural, social, and financial bonding activities and their impact on job satisfaction and loyalty.

Service industries that depend on front‐line employees to deliver high quality services are provided with innovative suggestions to improve job satisfaction and loyalty of their employees by employing an internal marketing approach. The study provides organizations with empirical evidence regarding the synergistic effects of bonding activities.

To the best of the authors' knowledge, this is the first time a hierarchical/sequential model of the impact that relationship bonds have on satisfaction and retention of health care staff has been empirically tested. The findings that structural bonds have both a direct and indirect impact on job satisfaction and loyalty are of value for interested academics working in this area and are relevant for companies trying to improve job satisfaction and loyalty of their employees.

The simulation of fracture processes for discrete crack propagation is well established for linear‐elastic cracking problems. Applying finite element techniques for the numerical formulation, at every incremental macro‐crack step the element mesh has to be adapted such that the crack path remains independent of the initial mesh. The accuracy of the obtained results has to be controlled by suitable error estimators and error indicators. Considering the dependence of the predicted crack path on the precision of the displacement and stress computation, quality measures for the computed results are recommended. In this research the use of the Babuska/Rheinboldt error indicator in combination with linear‐elastic crack propagation problems is demonstrated. Based on this error measure an adaptive mesh refinement technique is developed. In comparison with classical discrete crack propagation simulations the advantages of the new concept can be clearly observed.

The clean beauty phenomenon is gaining momentum and beauty brands are getting creative with on-pack sustainability claims. With the increasing focus on sustainability from both brands and consumers, sustainability communication has the potential to raise the profile of sustainable production and consumption. Further attention is needed on the creative approach behind on-pack sustainability marketing communications as companies no longer focus on single eco labels but instead use a bundle of claims to advertise their commitment to sustainability which finds consumers confused and brands open to accusations of greenwashing. This chapter explores on-pack sustainability communications in the beauty industry through the lenses of creative marketing communications which need to be both original and appropriate. This study contributes to the longstanding debate on the role of sustainability claims in marketing communications and addresses the role of on-pack sustainability claims design and creativity.

This study aims to reconcile some of the conflicting results in prior studies of the board structure–firm performance relationship and to evaluate the effectiveness and applicability of agency theory in the specific context of Italian corporate governance practice.

This research applies a dynamic generalised method of moments on a sample of Italian listed companies over the period 2003-2015. Proxies for corporate governance mechanisms are the board size, the level of board independence, ownership structure, shareholder agreements and CEO–chairman leadership.

While directors elected by minority shareholders are not able to impact performance, independent directors do have a non-linear effect on performance. Board size has a positive effect on firm performance for lower levels of board size. Ownership structure per se and shareholder agreements do not affect firm performance.

This paper contributes to the literature on agency theory by reconciling some of the conflicting results inherent in the board structure–performance relationship. Firm performance is not necessarily improved by having a high number of independent directors on the board. Ownership structure and composition do not affect firm performance; therefore, greater monitoring provided by concentrated ownership does not necessarily lead to stronger firm performance.

This paper suggests that Italian corporate governance law should improve the rules and effectiveness of minority directors by analysing whether they are able to impede the main shareholders to expropriate private benefits on the expenses of the minority. The legislator should not impose any restrictive regulations with regard to CEO duality, as the influence of CEO duality on performance may vary with respect to the unique characteristics of each company.

The results enrich the understanding of the applicability of agency theory in listed companies, especially in Italy. Additionally, this paper provides a comprehensive synthesis of research evidence of agency theory studies.

Communication and job satisfaction are two key factors for the success of public organisations. The study aims, firstly, to examine the effects of training activities and internal meetings on the perceived quality of communication processes; secondly, to explore the nuanced relationship between communication and job satisfaction.

This is a cross-sectional study based on results from organisational climate surveys conducted between 2019 and 2020 in six Italian Regional Healthcare Systems, involving a total of 58,888 employees. Linear regression models were performed.

Results highlight that employee satisfaction is positively influenced by high-quality internal communication. The organisation of frequent internal meetings and the offer of ad hoc training sessions on communication were found to be antecedents of good communication.

The study offers practical implications for healthcare organisations, highlighting specific strategies that can be employed to enhance internal communication and, subsequently, job satisfaction. The emphasis on training programmes and internal meetings provides actionable insights for organisational improvement.

The originality and value of this study lie in its unique large datasets, which significantly strengthen the reliability of the findings and make them more applicable to a wider range of contexts. Also, the exploration of the relationship between internal communication processes and job satisfaction within public healthcare organisations contributes to the growing body of knowledge in organisational studies.