Antecedents of customer aggressive behavior against healthcare employees

Purpose: The purpose of the research was to develop a tool for measuring antecedents of customer aggressive behavior (CAB) in healthcare service settings, by identifying its roots in organizational and interpersonal dynamics. Design/methodology/approach. Four studies were conducted. In studies 1 and 2, antecedents of CAB were identified through analysis of Internet reader comments and a questionnaire was distributed to students. In study 3, scenarios were used to validate the findings of the previous studies. Finally, in study 4, a scale was developed and validated for measuring organization- and person-related triggers of CAB using samples of 477 employees and 579 customers. Findings. The concept of CAB was conceptualized and validated. In total, 18 items were identified across five dimensions: personal characteristics; uncomfortable environment; aggressive role models; reinforcement of aggressive behavior; and aversive treatment. The scale demonstrated good psychometric results. Research limitations/implications. The research relies mainly on customer perspective. Employees and additional stakeholders should be included to achieve more accurate information that could contribute to a better understanding of CAB and its roots. Practical implications. Exploring social and organizational antecedents that trigger CAB could help healthcare managers evaluate and proactively manage CAB and its implications within their organization. Originality/value. This measurement scale is the first comprehensive tool, based on Bandura's Social Learning Theory (1973), that may identify and measure antecedents of CAB, and could be used to reduce CAB in healthcare service settings.