A qualitative study on patient impersonation (Malingering) behaviors of healthcare workers from the managers' perspective

As a behavior that can be observed in daily life, malingering has been the subject of much research. Since it was noticed that these studies were handled on the patient axis and written from a medical perspective, it was understood that the organizational context of malingering should be examined. The aim of this research, which set out to reveal the organizational context of the concept of malingering, is to evaluate how and why malingering behavior is exhibited in healthcare workers, its effects and solution strategies from a managerial perspective. For this purpose, the qualitative research method was preferred and the experiences of the participants about the malingering behavior were examined in depth through interviews with the phenomenology design. The participants of the study were selected by criterion and snowball sampling from purposive sampling methods. Interviews were conducted with a total of 20 people, including 1 chief nurse, 2 chief physicians, 2 deputy chief physicians, 2 unit supervisors, 4 laboratory supervisors and 9 service managers, who had observed malingering behavior through their own employees and who were/are managers. In this study, in-depth interview technique was used and a semi-structured interview form was used in the interviews. As a result of the interviews with the participants, 183 pages of data were collected. This research was designed with an interpretative phenomenological analysis approach and thematic data analysis method was used as the analysis technique. The findings were gathered under the themes of employee and managerial perception, causes of maltreatment behavior, characteristics of those who exhibit maltreatment behavior, recognition and interpretation of maltreatment behavior, how maltreatment behavior is exhibited, consequences of maltreatment behavior and methods to prevent maltreatment behavior. As a result of the research, it was seen that personal reasons, factors brought about by working conditions, failure to provide necessary management activities and structural factors cause maltreatment. Managers understood the malingering behavior when the behavior was repeated and there was no evidence, and they experienced negative emotional states at the moment of this awareness. The diseases claimed were preferred because they were mostly subjective in nature and especially because there was no proof afterwards. Healthcare workers used verbal and behavioral patterns while exhibiting the behavior. The person himself/herself, colleagues, managers, micro stakeholders, the institution, macro stakeholders, the health system and the state were affected by the malingering behavior. Structural and managerial strategies have been proposed to prevent this behavior. In case this behavior is exhibited, the manager should contact the employee, make a due diligence and decide on the practices to be implemented after evaluating whether the behavior is really malingering or not.