The relationship between burnout and mobbing among hospital managers

Abstract

Background:

Mobbing and burnout can cause serious consequences, especially for health workers and managers. Level of burnout and exposure to mobbing may trigger each other. There is a need to conduct additional and specific studies on the topic to develop some strategies.

Research objectives:

The purpose of this study is to determine the relationship between level of burnout and exposure to mobbing of the managers (head physician, assistant head physician, head nurse, assistant head nurse, administrator, assistant administrator) at the Ministry of Health hospitals.

Research design:

The “Leymann Inventory of Psychological Terrorization” scale was used to measure the level of exposure to mobbing and the “Maslach Burnout Inventory” scale was used to measure the level of burnout of hospital managers. The relationship between level of burnout and exposure to mobbing was analyzed by Pearson’s Correlation Analysis.

Participants and research context:

The population of this study included managers (454 managers) at the Ministry of Health hospitals in the metropolitan area of Ankara between September 2010 and May 2011. All the managers were tried to conduct, but some managers did not want to reply to the questionnaire and some managers were not found at their workplace. Consequently, using a convenience sampling, 54% of the managers replied to the questionnaire (244 managers).

Ethical consideration:

The approval of the study was granted by the Ministry of Health in Turkey. Furthermore, the study was evaluated and accepted by the Education, Planning and Coordination Council of one of the education and research hospitals in the study.

Findings:

Positive relationships were found among each subdimension of the mobbing and emotional exhaustion and depersonalization. A negative relationship was found between each subdimension of the mobbing and personal accomplishment.

Discussion:

In hospitals, by detecting mobbing actions, burnout may be prevented.

Conclusion:

Exposure to mobbing and burnout could be a serious problem for head nurses who are responsible for both the performance of the nurses and organization. Additionally, head nurses who are faced with mobbing and burnout are more likely to provide suboptimal services which could potentially result in negative outcomes. Therefore, this study draws attention to the importance of preventing these attitudes in the organization.

Keywords

Burnout head nurses head physicians hospital managers mobbing Turkey

Introduction

In recent years, organizations, especially in industrialized countries, have encountered mobbing, which is increasing quickly and insidiously and reducing the synergy and energy of organizations by increasing competition among workers.¹ In addition to increasingly difficult relationships among people at work, workers also encounter burnout.²

In a competitive environment, managers are responsible for the most difficult tasks in an organization. Exposure to mobbing and burnout can be serious problems for managers who are responsible for both the performance of the workers and organizations. Especially, in health organizations that are stressful and complex, levels of mobbing and burnout of managers are factors that could affect the success of an organization. Because error is unacceptable in healthcare, health services managed by mobbed and exhausted managers may be a negative factor that could affect the quality of care.

Although workplace mobbing has been found mostly in human service organizations in which burnout is experienced,³ studies about the relationship between mobbing and burnout on health workers are limited. There remains a gap in the literature in examining whether there is an association between mobbing and burnout in health services.

Mobbing could be harmful for both health workers and health organizations and cause many negative consequences. In evaluating whether burnout may be a negative consequence of mobbing or whether burnout may cause mobbing activities, it is important to prevent mobbing actions and burnout. Thus, in this study, we intended to determine the relationship between the level of burnout and exposure to mobbing of the managers at the Ministry of Health hospitals.

In this study, definitions of mobbing and burnout and their situation in healthcare are first explained. Then, the methods, purpose, participants, measures, and analyses of the study are explained. Finally, the results, discussion, and conclusions of the study are presented.

Mobbing

The term “mobbing” has been used by organizational scholars since the early 1980s⁴ to describe repeated workplace aggression.⁵ Mobbing was initially used by an ethologist to describe attacks by a group of smaller animals threatening a single larger animal. Later, a Swedish physician borrowed this terminology and called the destructive behavior of small groups of children directed against a single child “mobbing.” Leymann found a similar type of behavior in workplaces and used the word mobbing in the early 1980s.⁴ Leymann⁶ defined mobbing in working life as a hostile and unethical communication that is directed in a systematic way by one or a number of persons mainly toward one individual. Vandekerckhove and Commers⁵ defined mobbing as the repeated behavior of individuals or groups that intentionally harms others with whom they work.

Generally, almost all definitions of mobbing contain aggressive and systematic behavior, its frequency (being repeated), its duration, and imbalance of power.⁷ Additionally, some definitions indicate that mobbing behavior may cause adverse effects on the victim.⁸

First, there should be an aggressive and wearing purpose in mobbing behavior. Mobbing is a form of emotional abuse and starts with being the target of an irreverent and harmful behavior.⁹ Frequency and extended duration are two of the most important points to define a behavior as a mobbing action. Because mobbing is defined as a repeated process, a onetime aggressive action is not accepted as mobbing by most researchers.⁷ According to Leymann,⁴ mobbing actions occur often (at least once a week) and over a long period (at least 6 months), and because of high frequency and long duration, mobbing actions result in considerable psychological, psychosomatic, and social misery.

Mobbing is not an action that requires the use of symmetrical power; mostly it occurs in situations of disparity of power and status.¹⁰ Zapf et al.¹¹ have stated that the case studies described in the literature suggest that individuals in a weak power position are more likely to become mobbing victims. Even if a power disparity does not exist at the onset of mobbing, it may develop over time.

Many consequences may occur from mobbing behavior. Mobbing behavior creates consequences not only at the individual level, but also at the family, organization, and society levels.^1,4,9 The pressure of intentional and systematic mobbing actions may appear slowly at the individual level,¹² and the effects of the pressure may be different for each person.¹³ Leymann and Gustaffson¹⁴ classified mobbing symptoms at the individual level via factor analysis and found five factor groups that show the most revealing factor profiles. These groups indicate the cognitive effects of strong stressors producing psychological hyper-reactions, a syndrome with psychosomatic stress symptoms, symptoms arising in connection with the production of stress hormones and activities of the autonomic nervous system, some types of muscular tension symptoms, and sleep problems.

The consequences of mobbing may cause serious organizational consequences as well. Mobbing can result in high turnover, low morale, decreased productivity, increased absenteeism, and loss of key individuals. It may also shred teamwork, trust, and common purpose.¹⁵

Mobbing in healthcare

Whereas mobbing actions can appear in every type of organization,¹⁶ those in the health sector intensively entertain a risk of facing mobbing actions.^17
–19 There are some significant reasons for frequency of mobbing actions in the health sector: hospitals have strong and stressful working environment, and there are some difficulties, long working times, inadequate salaries, and some inequities in that environment.¹⁹ Moreover, because women intensively work in the health sector, mobbing actions in the health sector may be higher.¹⁸ According to many studies^17,20,21 most mobbing victims are nurses. Mobbing which is a serious occupational and health risk is seen frequently in the health sector and precautions should be taken against mobbing actions.²²

Burnout

Maslach et al.²³ stated that use of the term burnout began to appear with some regularity in the 1970s in the United States, especially among people working in human services. This popular usage was presaged by Greene’s 1961 novel, in which a spiritually tormented and disillusioned architect quits his job and withdraws into the African jungle. Previous literature, both fictional and nonfictional, described similar phenomena, including extreme fatigue and the loss of idealism and passion for one’s job. The importance of burnout as a social problem was identified by both practitioners and social commentators long before it became a focus of systematic study by researchers.

There are various definitions of burnout in the literature. Because there is no broadly approved definition, the understanding of burnout dynamics is difficult.²⁴ The definition of burnout was considered an occupational danger by the psychiatrist Freudenberger in 1974. According to Freudenberger,²⁵ “burnout meant that a staff member became exhausted from excessive demands on energy, strength or resources about a year after he or she began working.” Ergin²⁶ has stated that the most common current definition of burnout was made by Christina Maslach. According to Maslach and Jackson,²⁷ “burnout is a syndrome of emotional exhaustion and cynicism that occurs frequently among individuals who do ‘people-work’ of some kind.”

Maslach et al.²³ have studied how burnout could be assessed and identified three dimensions of burnout: emotional exhaustion, depersonalization, and reduced personal accomplishment. Maslach and Jackson²⁷ defined emotional exhaustion as the depletion of emotional resources and the feeling of not being able to give of oneself at a psychological level. Depersonalization refers to the employee’s negative perception of his or her recipients.²⁸ Reduced personal accomplishment is the tendency to evaluate oneself negatively²⁷ and is related conceptually to self-efficacy.²⁹

Definitions of burnout emphasize the gaps between personal ideals and aspirations and depleting conditions of the workplace.³⁰ Cordes and Dougherty³¹ also stated that definitions of burnout included the following: to fail, wear out, become exhausted; a loss of creativity; a loss of commitment for work; an estrangement from clients, co-workers, job, and agency; a response to the chronic stress of making it to the top; and a syndrome of inappropriate attitudes toward clients and toward self, often associated with uncomfortable physical and emotional symptoms.

Burnout in healthcare

Burnout is seen as an occupational risk that occurs frequently in various professionals in many types of organizations.³⁰ Especially, in occupations in which providing aid and servicing people in need is important, emotional and interpersonal stressors are more effective in causing burnout.²³ This situation is more important in healthcare. When health professionals experience burnout syndrome, they cannot meet the needs of patients and a lack of productivity and creative initiative may occur. Eventually, the quantity and quality of healthcare may fail and services can drag.^32,33 The use of the term “burnout” was first introduced to describe physical and emotional exhaustion in health professions.²⁵ This may show that burnout entertains a serious risk among health professions. Many studies have indicated that health professions are one of the riskiest occupational groups in experience burnout.^34
–36 Felton³⁷ stated that burnout is a work illness of health professions that should be diagnosed and treated early.

Although the burnout level of health professions differs among studies and countries, the overall burnout level of health professions is a serious issue. In Turkey, Turkish Health Union Central Office³⁸ found that the level of emotional exhaustion and depersonalization of health professions is average, and the level of reduced personal accomplishment is high. Altay et al.³⁶ found that the level of emotional exhaustion is high, and the level of depersonalization and reduced personal accomplishment is average in nurses. Kushnir et al.³⁹ stated that burnout levels of the physicians that were surveyed in the middle of 1990s and in 2001 are different from each other, and burnout has increased significantly.

Uncertain tasks and responsibilities, various education levels, managerial inadequacies in the health sector, lack of employee rights, long working times, unfavorable workplaces, work overload, and stress are seen as main factors of burnout in health services.³³ Moreover, requirements of providing aid to patients in need and servicing patients who have serious and deadly illnesses and encountering the expectations of patients and their families consistently make health professionals face burnout.^36,40,41 Additionally, health professionals may encounter physiological exhaustion when their patients die.⁴²

Burnout develops from physical, emotional, and psychological exhaustion. Some manifestations of physical exhaustion may be fatigue, insomnia, and weight fluctuations.⁴² Ekstedt and Fagerberg⁴³ explained emotional exhaustion of burnout in eight stages: inner incentive, feeling responsible, bodily and psychological manifestations, fatigue, threatened self-image, cutting off, and reaching the bottom. The third source of burnout that has health ramifications that are identifiable in healthcare is compassion fatigue. Wood and Killion⁴² expressed that if compassion fatigue occurs, the integrity of the relationship between the healthcare provider and the patient may be compromised. The healthcare professional may display behavior showing that he or she is detached from the needs of the patient, resulting in substandard care.

Health professionals who are faced with burnout are more likely to provide suboptimal services which could potentially result in negative outcomes.⁴² Cimiotti et al.⁴⁴ found a strong relationship between burnout level of nurses and infection rates. Because of the adverse consequences of burnout, factors that cause burnout should be minimized.

Mobbing and burnout

It is known that workplace mobbing has been found in human service organizations in which burnout is experienced.³ Researchers have emphasized that organizations most opportune to mobbing are human service organizations and at these organizations burnout may also occur.^8,45

Mobbing has been defined as “hostile and unethical communication which is directed in a systematic way take place often and over a long period and because of this frequency and duration, result in considerable psychic, psychosomatic and social misery”.⁶ Burnout could be an element of this psychic, psychosomatic and social misery.

Maslach and Leiter⁴⁶ categorized the causes of burnout in workers in an organization into six groups: overload, over control, lack of appreciation, inadequacy of social intercourse, inadequacy of justice and respect, and disagreement of values with organizations. Mobbing behaviors contain almost all these causes. If a worker is exposed to mobbing for a long time he would become exhausted.⁴⁷ Additionally, systematic and continuous mobbing policy causes a burnout process that appears as the loss of some emotions and behaviors such as despair, helplessness, and lack of action.⁴⁸

Few studies have analyzed the relationship between mobbing and burnout. Granau’s³ research in 2007 shows that there is a relationship between mobbing and burnout at schools. In Turkey, Sürgevil et al.⁴⁹ found that there is a positive relationship between mobbing and emotional exhaustion and depersonalization, and a negative relationship between mobbing and personal accomplishment in municipality employees. Dikmetaş et al.⁵⁰ analyzed the relationship between mobbing and burnout levels of resident doctors at a public university research and training hospital in Turkey and found that mobbing is a significant regressor for emotional exhaustion, depersonalization, and personal accomplishment. In another study, the results of a multiple regression analysis regarding prediction of mobbing demonstrated that burnout is a significant predictor of mobbing.⁵¹

According to the literature, workers face many negative effects as a result of mobbing. Determining if burnout is a result of mobbing or whether burnout causes mobbing activities is important to detect and prevent these actions.

Materials and methods

Research objectives

Although workplace mobbing has been found in human service organizations in which burnout is experienced, it is not known if workplace mobbing and burnout are related among managers in hospitals. In this study, we intended to determine the relationship between the level of burnout and exposure to mobbing of the managers (head physician, assistant head physician, head nurse, assistant head nurse, administrator, assistant administrator) at the Ministry of Health hospitals. In accordance with this purpose, our hypothesis is the following:

Hypothesis. There is a significant relationship between three subdimensions of burnout (emotional exhaustion, depersonalization, and personal accomplishment) and five dimensions of mobbing (activities on communication, social contacts, personal reputation, occupational situation, and physical health) for the hospital managers.

Participants and research context

The population of this study included managers (454 managers) at the Ministry of Health hospitals in the metropolitan area of Ankara. There were 19 Ministry of Health hospitals at the time of research. All the managers were tried to conduct, but some managers did not respond to the questionnaire and some managers were not found at their workplace. Consequently, using convenience sampling 54% of the managers replied to the questionnaire (244 managers).

Table 1 shows the frequency and percentage of participants. Most of the participants are assistant administrators and assistant head physicians. The number of assistant administrators and assistant head physicians is greater than the manager types. The participation rate of head physicians and assistant head physicians was 49%, the participation rate of the head nurses and assistant head nurses was 62%, and the participation rate of the administrators and assistant administrators was 52%. The general participation rate was 54%.

Table 1.

Population of the research and participants.

Position	Population	Participants
Position	Population	Frequent	Percent
Head physicians and assistant head physicians	179	88	49.1
Head nurses and assistant head nurses	93	58	62.3
Administrators and assistant administrators	182	98	53.8
Total	454	244	53.8

Ethical consideration

The approval for the study was granted by the Ministry of Health in Turkey. Furthermore, the study was evaluated and accepted by the Education, Planning and Coordination Council of one of the education and research hospitals in the study.

Before conducting the questionnaire, all participants were informed—both verbally and in written—about who was responsible for and why the study was being carried out. The participants were also notified that the study would not be used for any other reason and all the answers would be kept strictly confidential. Besides, participation in the study was completely voluntary; participants decided whether or not to participate.

Research design

The level of exposure to mobbing of hospital managers was assessed using the Leymann Inventory of Psychological Terrorization (LIPT). The LIPT includes 45 mobbing activities and five components identified by Leymann.⁴ In our study, the Cronbach’s alpha values for components of mobbing were 0.89 for the effects on the victims’ possibilities to communicate adequately, 0.65 for the effects on the victims’ possibilities to maintain social contacts, 0.81 for the effects on the victims’ possibilities to maintain their personal reputation, 0.82 for the effects on the victims’ personal occupation, and 0.71 for the effects on the victims’ physical health.

The levels of the three components of burnout were assessed using the Maslach Burnout Inventory (MBI).²⁷ The MBI was originally designed for use with people working in human services and healthcare because burnout appeared to be a particularly significant problem in these occupations. Recently, given the increasing interest in burnout, a general version of the MBI has been developed for use in any occupation. The MBI has been translated into many languages and is a common tool used internationally in research on burnout.⁵² Support has been shown for the internal reliability (Cronbach’s alpha, ranging from 0.71 to 0.90) and test–retest reliability (2- to 4-week intervals, ranging from 0.60 to 0.82).²⁷ Additional evidence of convergent and discriminant validity is reported in Maslach and Jackson’s²⁷ study.

In our study, the Cronbach’s alpha values for components of burnout were 0.87 for emotional exhaustion (nine items), 0.68 for depersonalization (five items), and 0.86 for personal accomplishment (eight items). Higher scores on emotional exhaustion and depersonalization and lower scores on personal accomplishment were associated with higher levels of burnout.

Analyses

The SPSS (Statistical Package for the Social Sciences) program was used to analyze the data. To assess the socio-demographic features of the hospital managers, descriptive statistics were used. To display if there was a significant relationship between the level of exposure to mobbing and level of burnout, Pearson’s Correlation Analysis was used.

Findings

Table 2 shows the following demographic characteristics of the participants: age, gender, marital status, education, position, and length of employment. The age of the participants ranged from 29 to 64, and 38.5% participants were between the ages of 50 and 64, 68.0% of the participants were male, and 75.4% were married. Head physicians and assistant head physicians comprised 36.1% of all participants; head nurses and assistant head nurses comprised 23.8%; and administrators and assistant administrators comprised 40.2% of all participants. The average age of all participants was 46, and the average length of employment in the hospital was 11 years.

Table 2.

Socio-demographic characteristic of participants.

Variables	n	%
Age
29–39	65	26.6
40–49	85	34.8
50–64	94	38.5
Gender
Male	166	68.0
Female	78	32.0
Marital status
Married	184	75.4
Single	60	24.6
Educational level
College and 2-year degree	51	20.9
License	151	61.9
Master	42	17.2
Position
Head physician and assistant head physician	88	36.1
Head nurse and assistant head nurse	58	23.8
Administrator and assistant administrator	98	40.2
Length of employment
0–5 years	38	15.6
6–13 years	126	51.6
14 years +	80	32.8
Total	244	100.0

Table 3 shows the results of Pearson’s Correlation Analysis of the relationship between emotional exhaustion and the subdimensions of mobbing. As shown in the table, there was a positive relationship between emotional exhaustion and all the subdimensions of mobbing. There was a positive and strong relationship between emotional exhaustion and activities on communication (r = 0.0778); a positive and medium relationship between emotional exhaustion and activities on social contacts (r = 0.619), personal reputation (r = 0.690), and occupational situation (r = 0.578); and a positive and weak relationship between emotional exhaustion and activities on physical health (r = 0.409).

Table 3.

Relationship between emotional exhaustion and subdimensions of mobbing.

Subdimensions of mobbing		Emotional exhaustion
Activities on communication	r	0.778
Activities on communication	p	0.000
Activities on social contacts	r	0.619
Activities on social contacts	p	0.000
Activities on personal reputation	r	0.690
Activities on personal reputation	p	0.000
Activities on occupational situation	r	0.578
Activities on occupational situation	p	0.000
Activities on physical health	r	0.409
Activities on physical health	p	0.000

Table 4 shows the results of Pearson’s Correlation Analysis of the relationship between depersonalization and the subdimensions of mobbing. There was a positive relationship between depersonalization and all the subdimensions of mobbing. There was a positive and medium relationship between depersonalization and activities on communication (r = 0.532), and personal reputation (r = 0.536), and a positive and weak relationship between depersonalization and activities on social contacts (r = 0.454), occupational situation (r = 0.406), and physical health (r = 0.348).

Table 4.

Relationship between depersonalization and subdimensions of mobbing.

Subdimensions of mobbing		Depersonalization
Activities on communication	r	0.532
Activities on communication	p	0.000
Activities on social contacts	r	0.454
Activities on social contacts	p	0.000
Activities on personal reputation	r	0.536
Activities on personal reputation	p	0.000
Activities on occupational situation	r	0.406
Activities on occupational situation	p	0.000
Activities on physical health	r	0.348
Activities on physical health	p	0.000

Table 5 shows the results of Pearson’s Correlation Analysis of the relationship between personal accomplishment and the subdimensions of mobbing. There was a negative relationship between personal accomplishment and all the subdimensions of mobbing. There was a negative and medium level relationship between personal accomplishment and activities on communication (r = −0.561), and personal reputation (r = −0.589); and a negative and weak relationship between personal accomplishment and activities on social contacts (r = −0.479), occupational situation (r = −0.437), and physical health (r = −0.482).

Table 5.

Relationship between personal accomplishment and subdimensions of mobbing.

Subdimensions of mobbing		Personal accomplishment
Activities on communication	r	−0.561
Activities on communication	p	0.000
Activities on social contacts	r	−0.479
Activities on social contacts	p	0.000
Activities on personal reputation	r	−0.589
Activities on personal reputation	p	0.000
Activities on occupational situation	r	−0.437
Activities on occupational situation	p	0.000
Activities on physical health	r	−0.482
Activities on physical health	p	0.000

The results confirmed our hypothesis. There was a significant relationship between three subdimensions of burnout and five dimensions of mobbing.

Discussion

It is important to determine whether burnout is a negative consequence of mobbing or if burnout causes mobbing activities in order to prevent these activities. In analyzing the relationship between mobbing and burnout among hospital managers, we identified a significant relationship between them.

According to the analysis, there was a positive relationship between emotional exhaustion and all the subdimensions of mobbing. There was a positive and strong relationship between emotional exhaustion and activities on communication (r = 0.0778); a positive and medium level relationship between emotional exhaustion and activities on social contacts (r = 0.619), personal reputation (r = 0.690), and occupational situation (r = 0.578); and a positive and weak relationship between emotional exhaustion and activities on physical health (r = 0.409). As a result, it may be said that exposure to mobbing could cause emotional exhaustion that is characterized by feeling tired off and distressed. Especially, the strong relationship between emotional exhaustion and activities on communication is an important finding and encourages preventing these activities. Communication among health professionals is very important for the quality and continuity of healthcare, and according to the results of the study, if communication worsens, emotional exhaustion may appear.

There was a positive relationship between depersonalization and all the subdimensions of mobbing. There was a positive and medium level relationship between depersonalization and activities on communication (r = 0.532) and personal reputation (r = 0.536); and a positive and weak relationship between depersonalization and activities on social contacts (r = 0.454), occupational situation (r = 0.406), and activities on physical health (r = 0.348). According to these results, mobbing can cause depersonalization that is characterized by becoming distant to the business, colleagues, and patients. This outcome may cause working without coordination, making mistakes, and being unconcerned about the patients.

Additionally, there was a negative relationship between personal accomplishment and all the subdimensions of mobbing. There was a negative and medium level relationship between personal accomplishment and activities on communication (r = −0.561) and personal reputation (r = −0.589); and a negative and weak relationship between personal accomplishment and activities on social contacts (r = −0.479), occupational situation (r = −0.437), and physical health (r = −0.482). As a result, it could be said that mobbing may cause low personal accomplishment that is characterized by symptoms of feelings of being inadequate and insufficient and low self-esteem.

Sürgevil et al.⁴⁹ found that there is positive relationship between each subdimension of mobbing and emotional exhaustion and depersonalization, and a negative relationship between each subdimension of mobbing and personal accomplishment, similar to this study. As a result of displaying this relationship, it could be said that exposure to mobbing may cause burnout or burnout may lay the groundwork for mobbing behavior. Thus, mobbing could be a reason or a result of burnout.

Conclusion

There was a positive relationship between each subdimension of mobbing and emotional exhaustion and depersonalization, and a negative relationship between each subdimension of mobbing and personal accomplishment among hospital managers. These findings indicate that hospital managers who are exposed to mobbing have more emotional exhaustion and depersonalization and less personal accomplishment.

“Activities on communication,” “on social contacts,” “on personal reputation” and “on occupational situation” were mostly related to “emotional exhaustion” and weakly related to “depersonalization.” “Activities on physical health” was most associated with “personal accomplishment” and least with “depersonalization.” According to these results, it could be said that overall mobbing activities are most associated with emotional exhaustion. In other words, exposure to mobbing makes workers mostly emotionally tired and exhausted. As Maslach and colleagues have mentioned, exhaustion is the most obvious manifestation of burnout syndrome and when people describe themselves or others as experiencing burnout, they are most often referring to the experience of exhaustion. Of the three aspects of burnout, exhaustion is the most widely reported and the most thoroughly analyzed.²³ Emotional exhaustion arises as a reaction to being affected by other people’s emotional requests.⁵³ Emotional exhaustion is characterized by a lack of energy and a feeling that one’s emotional resources are exhausted. This compassion fatigue may coexist with feelings of frustration and tension as workers realize they cannot continue to give themselves or be as responsible for clients as they have been in the past.³¹

Additionally, it could be said that when hospital managers are exposed to activities on physical health their personal accomplishment may be negatively influenced. As a result, they may have feelings of inability, failure, low efficiency, low productivity, poor self-confidence, and conflict with other workers.

Exposure to mobbing may cause burnout or burnout may lay the groundwork for mobbing behavior. When workers feel exhausted, they may be exposed to mobbing behavior more easily. Moreover, because exhausted workers do not adhere to organizational ethics rules and norms mobbing behavior could be discovered. Therefore, mobbing could be a reason or a result of burnout.

If mobbing and burnout increase together, workers may have physical and mental illnesses, team works may suffer, organizational dependence may be reduced, turnover may increase, and workers may not work effectively and efficiently, and as a result, the organizational image could be affected. As this study was conducted with hospital managers, issues of effectiveness and efficiency become more important. A hospital manager who does not work effectively and efficiently cannot lead hospital workers to be effective and efficient either.

This study was conducted with hospital managers in Ministry of Health hospitals. The level of exposure to mobbing and burnout may differ between private and university hospitals. Thus, it would be significant to conduct this research in those hospitals. Furthermore, in this study, the head physicians and assistant head physicians, head nurses and assistant head nurses, administrators and assistant administrators were evaluated as the group “managers.” Conducting separate evaluations of each managerial group would provide more detailed knowledge.

Footnotes

Conflict of interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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