Companies have a moral responsibility to treat customers fairly. One way for companies to do so is to allow their employees to exercise reasonableness in their interactions with customers. We define reasonableness as a latitude or space that exists around expectations in the delivery of service. In this paper, we explore the concept of reasonableness from a customer’s perspective (i.e., perceived reasonableness) and the role that the morals of service personnel play in customers’ perceptions of reasonableness. First, through an open-ended (...) survey on customers’ unreasonable service experiences, we identify themes of perceived reasonableness. We also discuss the role that the morals of service personnel play within these themes. Second, in order to identify the relationships between these themes, we create a cognitive map and discuss the implications of the identified relationships. Finally, we provide directions for future research on reasonableness. (shrink)

Background: Patient safety, which is a patient’s right, can be threatened by nursing errors. Furthermore, nurses’ feeling of “being a wrongdoer” in response to nursing errors can influence the quality of care they deliver. Research objectives: To explore the meaning of Iranian nurses’ experience of “being a wrongdoer.” Research design: A phenomenological approach was used to explore nurses’ lived experiences. Nurses were recruited purposively to take part in semistructured interviews, and the data collected from these interviews were analyzed using Van (...) Manen’s thematic analysis. Participants and research context: Eight nurses working in three private or governmental hospitals in Tehran, Iran. Ethical consideration: The research design was approved in each participating hospital, and all interviews were carried out at a predetermined time in a private place. Findings: Five themes were extracted from the data: “wandering in unpleasant feelings” (with two subthemes: “unpleasant physical feelings” and “unpleasant emotions”), “wandering in the conscience court” (with three subthemes: “being the accused,” “being the victim,” and “being the judge”), “being arrested in time,” “time for change” (with three subthemes: “promoting accountability,” “promoting learning,” and “strengthening supportive relationships”), and “spiritual exercise.” Discussion: Some of our results are supported by the model of self-reconciliation and the recovery trajectory of “second victims” theory. Conclusion: The meaning of “being a wrongdoer” has positive and negative aspects. Feelings of wandering provide nurses the opportunity to reflect on and re-embrace the professional and moral responsibility of nursing. Nursing managers can convert their “defeats” into a prelude to learning, increase their accountability, and improve the quality of nursing care. (shrink)

Background: Increasing attention to patients’ rights and their ability to choose their healthcare provider have changed the way patients can respond to untoward, disempowering and abusive healthcare encounters. These responses are often seen as crucial for quality improvement, yet they are little explored and conceptualized. Objective: To explore patients’ potential responses to untoward healthcare encounters and looking at their possible consequences for care quality improvement as well as for the individual patient. Research design: The article is structured looking at two (...) primary strategies: patient exit (leaving a healthcare provider) and patient voice (expressing grievances), derived from Hirschman (1970). These strategies were explored by the use of theoretical and empirical literature and applied to an individual patient case. The case functions as a pedagogical tool to illustrate and problematize what exit and voice strategies can mean for a single patient. Ethical considerations: The patient case is my version of a generalized scenario that is described elsewhere. It does not represent an individual patient’s story, but aims to be realistic and recognizable. Findings and conclusion: Based on the existing literature, it is hypothesized that, in their current form, exit and voice strategies have a limited effect on care quality and can come at a price for patients. However, both strategies may be of value to patients and providers. Therefore, the healthcare system could empower patients to engage in action and could further develop ways for providers to effectively use patients’ responses to improve practice and find ways to prevent patients from untoward experiences in healthcare. (shrink)