Applicability of the broken windows theory in healthcare institutions: A mixed-methods research study

The Broken Windows Theory is an approach that explains the impact of social disorder on individual behavior, and its applicability has been explored in various sectors. However, studies focusing on its implementation in the healthcare sector remain limited. The primary aim of this study is to develop an in-depth understanding of the applicability of the Broken Windows Theory in healthcare settings and to conduct a comprehensive evaluation by integrating qualitative findings with supporting quantitative data. Employing an exploratory sequential mixed methods research design, the study included 46 healthcare professionals selected through criterion sampling for the qualitative phase. In the first phase, qualitative data were collected through interviews and systematically analyzed using thematic analysis. As a result of the interviews, four main dimensions were identified: institutional functioning and behavioral dynamics, organizational resources and workplace ecosystem, socio-cultural dimension, and system/policy dimension. In the quantitative phase, the data obtained from the qualitative stage were transformed into the "Perception Scale of Broken Windows in Healthcare Organizations" and tested on a larger sample selected through convenience sampling. The structural validity of the scale was examined through exploratory and confirmatory factor analyses. Both qualitative and quantitative findings supported that the "Broken Windows Perception Scale in Healthcare Organizations" consists of the dimensions of institutional functioning and behavioral dynamics, as well as organizational resources and workplace ecosystem. The integration of findings underscores the necessity for institutional policies to address not only the improvement of the physical environment but also to enhance employee experiences, behavioral dynamics, and managerial sensitivity in tackling small-scale disorder. The study offers recommendations to consider not only individual responsibilities but also organizational structures and managerial attitudes in a holistic manner. This methodological approach allowed the research problem to be addressed from multiple perspectives and contributed to the development of more robust conclusions. In conclusion, this study demonstrates that the broken windows theory is applicable to the healthcare sector and offers a valuable perspective for understanding the impact of maintaining order within healthcare institutions on employee behavior.