Disruptive clinician behavior (DCB) refers to unethical and unprofessional behavior that seriously affects patient safety by disrupting relationships among healthcare professionals and causing dysfunctional communication and teamwork. DCB often persists as an organizational culture in Japanese healthcare settings because of problems in the conventional leadership system along with professional and positional hierarchies. Therefore, this study verified a causal model of DCB in Japanese healthcare, including triggers, response, and impact. Staff at two general hospitals (751 and 661 beds) were surveyed using a web-based questionnaire. In total, 256 staff who had experienced victimization and agreed to complete the questionnaire were included in this study. The questionnaire comprised demographic information, a DCB scale, and items covering causal indicators of DCB: triggers, response, and impact (psychological/social and medical/management). Mediation and moderated mediation analyses showed that: (1) DCB had a negative impact on the medical/managerial state, which was partially mediated by psychological/social impact; and (2) the responses of victims and others acted as a bulwark in reducing the psychological/social impact to some extent. SSION A prompt response to DCB as a bulwark reduces victims' psychological and social adaptation deterioration. Therefore, occurrences of DCB should not be overlooked, and the victim and those around them should respond positively. However, response as a bulwark cannot protect the organization's medical care and management. Therefore, it is important to prevent DCB.

The authors have declared no competing interest.

Grants-in-Aid for Scientific Research (22K10429)

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

the Human Research Ethics Committee of Ritsumeikan University (2022-106).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

All data produced in the present study are available upon reasonable request to the authors