{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T04:33:52Z","timestamp":1784608432609,"version":"3.55.0"},"reference-count":56,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T00:00:00Z","timestamp":1748390400000},"content-version":"unspecified","delay-in-days":27,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004543","name":"China Scholarship Council","doi-asserted-by":"publisher","award":["202107720007"],"award-info":[{"award-number":["202107720007"]}],"id":[{"id":"10.13039\/501100004543","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,4,30]]},"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Aggression and violence against physicians in hospitals is acknowledged to be an issue, and patients (and their relatives\/friends) have been identified as the most prevalent source. The aim of this study is to investigate the impact of patient aggression and violence against physicians on the team and organisational levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This is a qualitative interview study based on semistructured, in-depth individual interviews. Interview transcripts were coded and analysed in Atlas.ti.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Interviews were conducted in Chinese hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>This study involved 29 diverse participants, including physicians, hospital team leaders and hospital board members, working in two secondary hospitals and two tertiary hospitals in China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>This study found that, at the team level, aggression and violence by patients (and their relatives\/friends) can affect team climate, team communication, team beliefs and team resources. At the organisational level, such aggression and violence can have negative financial impacts (ie, involving compensation and additional costs) and societal impacts (ie, image and reputational damage, and public distrust). Although peer support and leaders\u2019 support were identified as important sources for physicians to deal with violent incidents, these sources were not used to their full potential.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Recovering a team climate after a violent incident and providing diverse forms of support, especially proactive support from leaders and peers, represent two important approaches to cope with the negative impact of patient (and their relatives\/friends) aggression and violence against physicians on both team and organisational levels.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-092229","type":"journal-article","created":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T05:20:33Z","timestamp":1748496033000},"page":"e092229","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Impact of patient aggression and violence against physicians on the team and organisational levels in China: a qualitative study"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4340-4390","authenticated-orcid":false,"given":"Yuhan","family":"Wu","sequence":"first","affiliation":[{"name":"Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9973-3746","authenticated-orcid":false,"given":"Kees","family":"Ahaus","sequence":"additional","affiliation":[{"name":"Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dahai","family":"Zhao","sequence":"additional","affiliation":[{"name":"School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9608-180X","authenticated-orcid":false,"given":"Martina","family":"Buljac-Samardzic","sequence":"additional","affiliation":[{"name":"Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,5,28]]},"reference":[{"key":"2025121403594715000_15.5.e092229.1","doi-asserted-by":"crossref","first-page":"101573","DOI":"10.1016\/j.avb.2021.101573","article-title":"Workplace violence in healthcare: Towards a psychosocial perspective","volume":"58","author":"Bhattacharjee","year":"2021","journal-title":"Aggress Violent Behav"},{"key":"2025121403594715000_15.5.e092229.2","doi-asserted-by":"publisher","DOI":"10.4103\/jpgm.JPGM_96_20"},{"key":"2025121403594715000_15.5.e092229.3","doi-asserted-by":"crossref","first-page":"429","DOI":"10.5811\/westjem.2011.12.6795","article-title":"Development of a Data Collection Instrument for Violent Patient Encounters against Healthcare Workers","volume":"13","author":"Kowalenko","year":"2012","journal-title":"West J Emerg Med"},{"key":"2025121403594715000_15.5.e092229.4","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1016\/j.avb.2013.07.014","article-title":"A review of research on the prevalence, antecedents, consequences and prevention of workplace aggression in clinical medical practice","volume":"18","author":"Hills","year":"2013","journal-title":"Aggress Violent Behav"},{"key":"2025121403594715000_15.5.e092229.5","doi-asserted-by":"crossref","first-page":"101892","DOI":"10.1016\/j.avb.2023.101892","article-title":"Prevalence, risk factors, consequences, and prevention and management of patient aggression and violence against physicians in hospitals: A systematic review","volume":"74","author":"Wu","year":"2024","journal-title":"Aggress Violent Behav"},{"key":"2025121403594715000_15.5.e092229.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.avb.2020.101381"},{"key":"2025121403594715000_15.5.e092229.7","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1016\/j.colegn.2018.04.003","article-title":"Prevention and management of occupational violence and aggression in healthcare: A scoping review","volume":"25","author":"Morphet","year":"2018","journal-title":"Collegian"},{"key":"2025121403594715000_15.5.e092229.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.avb.2014.07.010"},{"key":"2025121403594715000_15.5.e092229.9","doi-asserted-by":"publisher","DOI":"10.1177\/1059601106286784"},{"key":"2025121403594715000_15.5.e092229.10","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1108\/EJTD-01-2022-0002","article-title":"Emotion in teams: a scoping literature review","volume":"47","author":"Xie","year":"2023","journal-title":"EJTD"},{"key":"2025121403594715000_15.5.e092229.11","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.obhdp.2014.09.004","article-title":"Turning shame into creativity: The importance of exposure to creative team environments","volume":"126","author":"Gonz\u00e1lez-G\u00f3mez","year":"2015","journal-title":"Organ Behav Hum Decis Process"},{"key":"2025121403594715000_15.5.e092229.12","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1108\/IJCMA-02-2016-0009","article-title":"Burning hearts in conflict: new perspectives on the intragroup conflict and team effectiveness relationship","volume":"28","author":"Hjerto","year":"2017","journal-title":"International Journal of Conflict Management"},{"key":"2025121403594715000_15.5.e092229.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ienj.2019.02.001"},{"key":"2025121403594715000_15.5.e092229.14","doi-asserted-by":"publisher","DOI":"10.1111\/jonm.12488"},{"key":"2025121403594715000_15.5.e092229.15","doi-asserted-by":"crossref","unstructured":"Eshah N , Al Jabri OJ , Aljboor MA , et al . Workplace Violence Against Healthcare Workers: A Literature Review. SAGE Open Nursing 2024;10. doi:10.1177\/23779608241258029","DOI":"10.1177\/23779608241258029"},{"key":"2025121403594715000_15.5.e092229.16","doi-asserted-by":"crossref","DOI":"10.1016\/j.aprim.2024.102944","article-title":"Guardians of health under fire: Understanding and combating violence against doctors","volume":"56","author":"Y\u00fccel \u00d6zden","year":"2024","journal-title":"Aten Primaria"},{"key":"2025121403594715000_15.5.e092229.17","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-025942","article-title":"Cross-sectional study on patient-physician aggression in Belgium: physician characteristics and aggression types","volume":"9","author":"De Jager","year":"2019","journal-title":"BMJ Open"},{"key":"2025121403594715000_15.5.e092229.18","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-020-05084-x","article-title":"Determinants of aggression against all health care workers in a large-sized university hospital","volume":"20","author":"Viottini","year":"2020","journal-title":"BMC Health Serv Res"},{"key":"2025121403594715000_15.5.e092229.19","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/j.jflm.2007.03.004","article-title":"Aggression and violence towards health care providers--a problem in Turkey?","volume":"14","author":"Erkol","year":"2007","journal-title":"J Forensic Leg Med"},{"key":"2025121403594715000_15.5.e092229.20","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2016-013568","article-title":"Workplace violence against physicians in Turkey\u2019s emergency departments: a cross-sectional survey","volume":"7","author":"Bayram","year":"2017","journal-title":"BMJ Open"},{"key":"2025121403594715000_15.5.e092229.21","doi-asserted-by":"crossref","DOI":"10.1186\/s12245-020-00290-0","article-title":"A qualitative study of workplace violence among healthcare providers in emergency departments in India","volume":"13","author":"Davey","year":"2020","journal-title":"Int J Emerg Med"},{"key":"2025121403594715000_15.5.e092229.22","unstructured":"International Labor Office, International Council of Nurses, World Health Organization, et al . Framework guidelines for addressing workplace violence in the health sector. joint program on workplace violence in the health sector. Geneva International Labour Office; 2002."},{"key":"2025121403594715000_15.5.e092229.23","doi-asserted-by":"publisher","DOI":"10.1136\/oemed-2019-105849"},{"key":"2025121403594715000_15.5.e092229.24","doi-asserted-by":"publisher","DOI":"10.1177\/1524838018774429"},{"key":"2025121403594715000_15.5.e092229.25","doi-asserted-by":"crossref","first-page":"112386","DOI":"10.1016\/j.socscimed.2019.112386","article-title":"Impact of China\u2019s referral reform on the equity and spatial accessibility of healthcare resources: A case study of Beijing","volume":"235","author":"Lu","year":"2019","journal-title":"Soc Sci Med"},{"key":"2025121403594715000_15.5.e092229.26","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)32136-1"},{"key":"2025121403594715000_15.5.e092229.27","doi-asserted-by":"publisher","DOI":"10.1007\/s10508-012-0016-6"},{"key":"2025121403594715000_15.5.e092229.28","doi-asserted-by":"publisher","DOI":"10.1002\/smj.4250120604"},{"key":"2025121403594715000_15.5.e092229.29","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1177\/1094428112452151","article-title":"Seeking qualitative rigor in inductive research: Notes on the Gioia methodology","volume":"16","author":"Gioia","year":"2013","journal-title":"Organ Res Methods"},{"key":"2025121403594715000_15.5.e092229.30","doi-asserted-by":"publisher","DOI":"10.1177\/0021886320982715"},{"key":"2025121403594715000_15.5.e092229.31","unstructured":"Bakker AB , Demerouti E . Schaufeli wb.the socially induced burnout model. In: Shohov SP , ed. Advances in psychology research, 25. New York: Nova Science, 2003: 13\u201330."},{"key":"2025121403594715000_15.5.e092229.32","doi-asserted-by":"publisher","DOI":"10.1037\/0021-9010.85.6.848"},{"key":"2025121403594715000_15.5.e092229.33","doi-asserted-by":"publisher","DOI":"10.2307\/3094912"},{"key":"2025121403594715000_15.5.e092229.34","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-023-47720-6","article-title":"Defensive medicine practices as a result of malpractice claims and workplace physical violence: a cross-sectional study from Egypt","volume":"13","author":"Arafa","year":"2023","journal-title":"Sci Rep"},{"key":"2025121403594715000_15.5.e092229.35","doi-asserted-by":"crossref","first-page":"1352","DOI":"10.1177\/00187267221104011","article-title":"Working around: Job crafting in the context of public and professional accountability","volume":"76","author":"Renkema","year":"2023","journal-title":"Human Relations"},{"key":"2025121403594715000_15.5.e092229.36","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2021.02.005"},{"key":"2025121403594715000_15.5.e092229.37","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-057169","article-title":"How defensive medicine is defined in European medical literature: a systematic review","volume":"12","author":"Baungaard","year":"2022","journal-title":"BMJ Open"},{"key":"2025121403594715000_15.5.e092229.38","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1108\/ER-02-2017-0043","article-title":"Consequences of workplace violence behaviors in Jordanian public hospitals","volume":"40","author":"Al-Shiyab","year":"2018","journal-title":"ER"},{"key":"2025121403594715000_15.5.e092229.39","first-page":"1256","article-title":"Consequences of workplace violence directed at nurses","volume":"18","author":"Chapman","year":"2009","journal-title":"Br J Nurs"},{"key":"2025121403594715000_15.5.e092229.40","unstructured":"Meyer E . The culture map: breaking through the invisible boundaries of global business. New York, NY Public Affairs; 2014."},{"key":"2025121403594715000_15.5.e092229.41","doi-asserted-by":"crossref","first-page":"1082070","DOI":"10.3389\/fpubh.2023.1082070","article-title":"Factors and interventions determining the functioning of health care teams in county-level hospitals in less affluent areas of China: a qualitative study","volume":"11","author":"Wang","year":"2023","journal-title":"Front Public Health"},{"key":"2025121403594715000_15.5.e092229.42","doi-asserted-by":"publisher","DOI":"10.1037\/1076-8998.8.2.110"},{"key":"2025121403594715000_15.5.e092229.43","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph121114429"},{"key":"2025121403594715000_15.5.e092229.44","unstructured":"Hofstede Insights . Country comparison. Available: https:\/\/www.hofstede-insights.com\/contry-comparison\/ [Accessed 29 Sep 2022]."},{"key":"2025121403594715000_15.5.e092229.45","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0157897","article-title":"Coping with Workplace Violence against General Practitioners and Nurses in Heilongjiang Province, China: Social Supports and Prevention Strategies","volume":"11","author":"Zhao","year":"2016","journal-title":"PLoS ONE"},{"key":"2025121403594715000_15.5.e092229.46","doi-asserted-by":"crossref","unstructured":"Hofstede G . Dimensionalizing Cultures: The Hofstede Model in Context. Online Readings in Psychology and Culture 2011;2. doi:10.9707\/2307-0919.1014","DOI":"10.9707\/2307-0919.1014"},{"key":"2025121403594715000_15.5.e092229.47","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0277489","article-title":"Physician exhaustion and work engagement during the COVID-19 pandemic: A longitudinal survey into the role of resources and support interventions","volume":"18","author":"Solms","year":"2023","journal-title":"PLoS One"},{"key":"2025121403594715000_15.5.e092229.48","doi-asserted-by":"publisher","DOI":"10.1037\/ocp0000180"},{"key":"2025121403594715000_15.5.e092229.49","doi-asserted-by":"publisher","DOI":"10.1080\/17513050902985331"},{"key":"2025121403594715000_15.5.e092229.50","doi-asserted-by":"crossref","first-page":"0046958020969313","DOI":"10.1177\/0046958020969313","article-title":"Effect of Workplace Violence on Turnover Intention: The Mediating Roles of Job Control, Psychological Demands, and Social Support","volume":"57","author":"Yeh","year":"2020","journal-title":"Inquiry"},{"key":"2025121403594715000_15.5.e092229.51","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph13080811","article-title":"Concern about Workplace Violence and Its Risk Factors in Chinese Township Hospitals: A Cross-Sectional Study","volume":"13","author":"Xing","year":"2016","journal-title":"Int J Environ Res Public Health"},{"key":"2025121403594715000_15.5.e092229.52","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0128394","article-title":"The Frequency of Patient-Initiated Violence and Its Psychological Impact on Physicians in China: A Cross-Sectional Study","volume":"10","author":"Shi","year":"2015","journal-title":"PLoS ONE"},{"key":"2025121403594715000_15.5.e092229.53","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1111\/jocn.15169","article-title":"Team efficacy and leadership in managing aggressive situations in the general hospital setting: A qualitative descriptive analysis of focus groups with ward managers","volume":"29","author":"Heckemann","year":"2020","journal-title":"J Clin Nurs"},{"key":"2025121403594715000_15.5.e092229.54","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1111\/jonm.12772","article-title":"Patient and visitor aggression in healthcare: A survey exploring organisational safety culture and team efficacy","volume":"27","author":"Heckemann","year":"2019","journal-title":"J Nurs Manag"},{"key":"2025121403594715000_15.5.e092229.55","doi-asserted-by":"crossref","DOI":"10.1016\/j.eclinm.2024.102641","article-title":"The growing burden of workplace violence against healthcare workers: trends in prevalence, risk factors, consequences, and prevention - a narrative review","volume":"72","author":"O\u2019Brien","year":"2024","journal-title":"EClinicalMedicine"},{"key":"2025121403594715000_15.5.e092229.56","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsr.2003.09.018"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-092229","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T11:59:58Z","timestamp":1765713598000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-092229"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5]]},"references-count":56,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5,28]]},"published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.1136\/bmjopen-2024-092229"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-092229","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5]]}}}