AGGRESSION
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AGGRESSION

A behavior with intent to harm (Rippon, 2000)
Sabotage to property
Screaming
Threats
Raising voice
Sewing
Violence
Throwing objects
Hitting
Buss, 1961:
- Physical versus verbal aggression
- Direct versus indirect aggression
Degree of threat:
The perceived intensity of an aggressive act and its consequences
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AGGRESSION TYPES (BUSS, 1961):
Physica
l
Indirect
Direct
Verba
l
Degree of threat:
The perceived intensity of an aggressive act and its
consequences
AGGRESSION IN QUEUES – THE VALUE OF HOPE
DORIT EFRAT TREISTER, ARIK CHESHIN, DANA
HARARI, SHIRA AGASI, ANAT RAFAELI, HADAR
MORIAH
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AGGRESSION: SEVERE, INTERNATIONAL,
COSTLY
Indirect costs -performance errors (Miron-Spektor & Rafaeli,
2009)
5 2009).
compliance with perpetrator requests (Van Kleef,
AGGRESSION IN SERVICE
ORGANIZATIONS:

Workplace aggression: Situational triggers are
critical in eliciting aggression (Hershcovis et al., 2007).

Waiting, queues – inherently built into service
organizations

Can’t screen patients

ED atmosphere - induces frustration and
aggression (Cheshin, Rafaeli, & Eisenman, 2012; Landau & Bendalak, 2008)
Introduction
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WHICH SITUATIONAL TRIGGERS INDUCE
AGGRESSION?
Wait?


Blocks goal of visit  frustrating (Rafaeli, Barron, & Haber, 2002)
Prolongs exposure to aversive conditions (Griffitt & Veitch, 1971;
Berkowitz, 1989)

Violates psychological contract for fast treatment (Rousseau,
2001)
Waiting enhances aggression
Introduction
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WHICH SITUATIONAL TRIGGERS INDUCE
AGGRESSION?
Crowdedness?
Averse conditions:
Heat, claustrophobia, anxiety, fear of disease (Tse et al.,
2002)
Crowdedness enhances aggression
Introduction
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WHICH SITUATIONAL TRIGGERS INDUCE
AGGRESSION?
 The
longer the wait, the longer the
exposure to the crowdedness and the
averse conditions.
 Frustration-
Aggression
(Dollard, Miller, Doob, Mowrer & Sears, 1939; Berkowitz, 1989)
Waiting and crowdedness have a combined
effect, together enhancing aggression
Introduction
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WHY DO WAIT AND CROWDEDNESS
TO AGGRESSION?
LEAD
A function of the hospital load:
 Hospital
Systems Load (Pedroja et al., 2014):
Surgeries, ambulances arriving, discharges,
transfers,
no. of patients, hours in ED…

 Perceived
load:
An examination of the burden on the system, the
busyness
 A holistic view

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UNFOLDING THE WAIT
Expected Wait
Introduction
Past Wait
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UNFOLDING THE WAIT
Stressors:
Crowdedness?
Past wait?
Expected wait?
Introduction
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SITUATIONAL STRESSORS
 Crowdedness:

level of averse conditions
 Past

wait:
familiarity with queue, fatigue, exposure duration
 Expected



wait:
goal proximity (Weiss, Rafaeli & Monichur, 2007)
Hope - Light at the end of the tunnel /
Frustration - No end to the tunnel
Load perception
Aggression
Introduction
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PREDICTIONS
Crowdedness, past wait, expected wait  Perceived load,
aggression
Crowdedness/ Low
Past
Wait
High
Expected Wait
Low
High
Introduction
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METHOD
• N= 226 patients & escorts waiting in an ED
• 56% female, Mage=34
Objective measures: from hospital operation records
 Past
wait: (M = 2.55 hrs, SD = 2.26)
Hospital records of the time passed since a patient checked into ED
and until survey completion
 Crowdedness:
(M = 37.33, SD = 22.38)
Number of people in ED while completing survey
 Actual
Aggression:
Reports of aggression to security within an hour of survey
completion (30 minutes before & 30 minutes after).
Introduction
Method
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Method
Subjective measures:
 Perceived
load (Tse, et al., 2002)
Sample item: “The ED is loaded”
(4-items; α = .77; M = 4.34, SD = 2.26).
 Expected
Wait:
“How much time do you think you still have to wait in the
ED”
(M = 1.74hrs, SD = 1.55).
 Perceived
Aggression (Severance et al., 2013)
Sample item: “Someone will soon hit a medical staff
member”;
“Someone will soon damage hospital property”
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Introduction α =Method
(12-items;
.94; M = 2.96, SD = 1.58).
WHAT ABOUT THE WAIT INFLUENCED
PERCEIVED LOAD?
β= -1.05*
Individuals who expect a long wait, are so frustrated, they
are not influenced by past wait
Introduction
Method
Results
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WHAT ABOUT THE WAIT INFLUENCES
AGGRESSION?
β= .02
Expected wait influences aggression above and beyond past wait
Introduction
Method
Results
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EXPECTED WAIT BUFFERS THE INFLUENCE OF
CROWDEDNESS ON AGGRESSION
β= .08***
CI[-.04; .01]
Hope buffers aggression
Introduction
Method
Results
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IMPLICATIONS AND CONTRIBUTIONS
 Theoretical:
The value of hope: useful, immediate
- Wait, crowdedness, hope
-
 Aggression
stems from:
Interpretation of objective reality
- Stressors: crowdedness & expected wait
- not past wait
-
Show the light at the end of the tunnel
Introduction
Method
Results
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Discussion
GENERAL DISCUSSION
Aggression
 Can be managed:
Spread out the crowd
 Show the light at the end of the tunnel

 What
type of conflict is leads to aggression in
queues?
Introduction
Method
Results
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Discussion
Thank you!
Questions?
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