From psychological contract to social contract: A research on the origins of violence in health

This study aims to examine the roots of violence in healthcare through the conceptual frameworks of the psychological contract and the social contract. Based on the experiences of healthcare workers employed at a public hospital in Afyonkarahisar and the patients receiving services from this institution, the research seeks to uncover the underlying causes of violence and the mutual expectations of both parties. The main objective of the study is to understand the psychological, social, and organizational dynamics of violence against healthcare professionals and to develop potential solutions to this problem. The research was designed using a qualitative method, and data were collected through semi-structured interviews with 15 healthcare workers and 15 patients at a state hospital in Afyon. Participants were selected through purposive sampling, and interviews were conducted face-to-face and recorded. Descriptive analysis was used to analyze the data, and common themes were identified and interpreted. The findings of the study indicate that a mismatch in expectations between healthcare workers and patients is one of the main causes of violence. While healthcare workers expect better working conditions, security measures, and institutional support from the system and hospital management, patients expect higher-quality service, respectful communication, and prompt solutions. Violations of the psychological contract (the unwritten expectations between the organization and the employee) and the inconsistency between societal expectations in the context of the social contract and the actual services provided by the healthcare system play a critical role in the emergence of violence. The study emphasizes that violence in healthcare is not only an individual issue but also a problem with organizational, managerial, and societal dimensions. In this context, it is recommended to develop multi-dimensional strategies to prevent violence. Among the key recommendations of the study are: hospitals should implement measures to improve staff safety, organize training programs to enhance patient-provider communication, and raise public awareness about healthcare professionals. In conclusion, this study highlights the significance of the psychological and social contract concepts in understanding the roots of violence in healthcare and offers an interdisciplinary perspective to the literature. The findings provide not only academic contributions but also practical solutions for policymakers and hospital administrators. In this way, the study aims to foster a healthier patient-healthcare worker relationship and reduce incidents of violence.