Date Published: June 24, 2019
Publisher: Public Library of Science
Author(s): Dorit Efrat-Treister, Arik Cheshin, Dana Harari, Anat Rafaeli, Shira Agasi, Hadar Moriah, Hanna Admi, Melita J. Giummarra.
Queues are inherent to service encounters, as it is not always possible to provide service to all clients at the exact moment they request service. Queues involve waiting for a service in a specific place that might also be crowded, they obstruct the client’s’ goal of receiving service, and at times lead clients to mistreat service providers and in extreme cases even attack them violently. We show, in a hospital setting, that perceived predicted future wait and load can buffer the causes of violence towards service staff.
We combine objective data on crowdedness, reports of violence, and durations of time people waited, with psychological measures of perceived load and perceived future wait, collected from 226 people in the Emergency Department (ED) of a large hospital. Visitors to the ED were recruited as they waited for service. They indicated their perceived load in the ED and their perceived remaining wait for service. This data was then triangulated with objective operational data regarding the actual number of people waiting for service (i.e., crowdedness) and objective data regarding staff calls to security to stop violent accounts.
We find that with increased crowdedness, there are more calls to security reporting violence. However, this relationship is moderated by two factors: when people perceive the future wait to be short and when they perceive the load on the system to be high. Moreover, a three-way interaction shows that crowdedness is associated with more incidents of violence, however high perceived load and low perceived future wait are associated with fewer violent incidents.
This paper demonstrates the relationship between crowded queues and violence towards service staff, and suggests two psychological mechanisms for buffering such violence: reducing perceived future wait and elevating perceived load.
Queues and wait are an inevitable part of service delivery . Queues are notoriously stressful and frustrating, especially if they are long and slow moving. Long queues obstruct goal achievement [2,3,4] and create an experience of crowdedness, that can elevate client aggression towards service providers , and in extreme cases even violently [6,7,8]. Efforts to reduce such aggression and violence include increasing the number of available service staff (which should objectively make the queue move faster and reduce crowdedness) and enlarging the waiting area (which should make the queue appear shorter and reduce perceived crowdedness ). These options are, however, expensive  and often unavailable in many service contexts such as hospital Emergency Departments (EDs), the setting examined in the current paper. Hospital EDs, suffer from long wait times and crowdedness, both of which have a major influence on client violence .
Research on violence and aggression in field settings is lacking [37,38,39]. Aggression is defined as “intentional behavior directed at doing harm to a living being whether harm results or not, that can be physical or verbal, active or passive, and can be directly or indirectly focused on the victim(s)” . Violence is the extreme end of aggression, and is our focus in this paper, defined as “any aggressive act that has as its goal extreme physical harm”  p246. We draw from literature on aggression, which is far more developed, to predict when violence will occur, since violence typically occurs as an escalation of aggression. The prevailing general aggression model  describes the likelihood of an individual behaving aggressively towards another person and suggests that there are proximate processes and distal causes and processes that lead to different levels of aggression. Our current paper examines proximate processes that can explain individual episodes of aggression, concentrating specifically on the situational factors that cause extreme aggression, and thus violence. The queue context is characterized by high stress, a sense of rejection, frustration, anonymity, bad moods, noise, heat, fear, identity threat, and a sense of injustice, all of which may trigger aggression that might escalate into violence [39,40,41,42,43,44].
Crowdedness is defined objectively as the density of people in a specific space . From an operations perspective, crowdedness is the extent to which demand for a service exceeds the ability to deliver that service in a timely fashion . Simply put, crowdedness reflects the number of people competing for the system’s attention [49,50]. Crowdedness also has a psychological quality. Research in the social sciences shows that crowdedness, oftentimes referred to as load, violates people’s sense of personal space and leads to feelings of helplessness [51,52,53,54,55]. These feelings increase arousal and a tendency to blame others for adverse situations . Moreover, increased temperature, a characteristic of crowded environments, is an antecedent of aggression and violence . Altogether this means crowdedness increases stress , and as such can beget destructive behaviors such as aggression and violence [40,59,60,61]. Thus, our first hypothesis connects crowdedness to violence, predicting that a more crowded waiting area will lead to more reports of violence towards service staff.
A second operational aspect of queues that acts as a stressor is the amount of time spent waiting . Time is a resource with significant monetary and personal value [62,63,64,65], and spending this valuable resource waiting for service (or in common parlance, “wasting time”) is frustrating . This frustration increases the likelihood of aggression and violence [2,3,4,60]
A particularly stressful aspect of queuing is the uncertainty regarding the length of time remaining before the person waiting reaches the head of the queue and is served . We suggest that even under crowded conditions, a short perceived future wait time can offer hope, and this effect is strong enough to buffer the harmful psychological effects of crowdedness (the violations of personal space, frustration, sense of helplessness, and sensory load). Hope, or “belief in the possibility of a favorable outcome” , is linked to future-oriented and positive thinking . Hope in this respect is situational, and represents people’s speculations regarding how much longer they expect to remain waiting. As such, it is a source of motivation  and a vital coping resource that can help buffer the stress of waiting . According to this reasoning, a short perceived future wait reduces the stress and frustration of waiting as well as the tendency to act violently. We predict the more crowded the queue, the more distressing the situation, and the more important the length of perceived future wait in buffering the effects of crowdedness on violence. Therefore, our second hypothesis posits that perceived future wait buffers the relationship between crowdedness and violence towards service staff, such that the shorter the perceived future wait the weaker the relationship between crowdedness and violence.
A key to understanding the dynamics of a given queue is how many people are present, which is defined as the system load . Aside from the actual system load, people attribute meanings to the number of people present, which we define as people’s perceived load. We posit that perceptions of load are critical in shaping the behavior of people waiting, because these perceptions help people understand why they are waiting. These perceptions in turn influence behavior, through a process known as “sensemaking” [81,82], which describes how people experience and react to a given situation . A large number of people waiting in a queue leads the people waiting to perceive the system as loaded  and enhances perceived wait durations [85,86,87]. Such perceptions of high workload lead people to adjust their expectations. Thus, our third hypothesis predicts that perceived load buffers the relationship between crowdedness and violence towards service staff, such that the higher the perceived load the weaker the relationship between crowdedness and violence.
In sum, our first hypothesis (H1) is that crowdedness is associated with increased incidents of violence. In Hypotheses 2 and 3, we posit that perceived future wait (H2) and perceived load (H3) moderate the relationship between crowdedness and violence. The final leg of our argument integrates the two latter factors–perceived future wait and perceived load. We suggest that the combined effect of perceived future wait and perceived load synergistically buffers the effect of crowdedness on violent attacks against service staff. Specifically, we predict that the weakest relationship between objective crowdedness and violence occurs when the perceived future wait is lowest and the perceived load is highest. In other words, in our fourth and final hypothesis we propose a three-way interaction; crowdedness, perceived future wait, and perceived load have a combined three-way interactive relationship with violence towards service staff, such that crowdedness is associated with increased incidents of violence, however violence is lowest when perceived future wait is lowest and perceived load is highest.
Table 1 provides the means, standard deviations, and inter-correlations of all study variables. Participants in the study (N) = 226 had been waiting in the ED (95% response rate) anywhere from a few minutes to 12 hours (56% female; Meanage = 33.99, SDage = 13.60; Meaneducation = 13.31 years, SDeducation= 2.19 years).
Our study shows that the association between crowdedness and violence is moderated by psychological evaluations of future wait and perceived load on the system. These operational variables were impacted by psychological measures of perceived future wait and perceived load. When clients waiting in a crowded ED perceived their future wait time as short, and the load in the ED as high, there was a weaker association between crowdedness and violence. A three-way interaction shows further that high perceived load and low perceived future wait are associated with fewer incidents of violence.