• Research article
  • Open access
  • Published: 04 December 2020

An empirical application of “broken windows” and related theories in healthcare: examining disorder, patient safety, staff outcomes, and collective efficacy in hospitals

  • Louise A. Ellis   ORCID: orcid.org/0000-0001-6902-4578 1 ,
  • Kate Churruca 1 ,
  • Yvonne Tran 1 ,
  • Janet C. Long 1 ,
  • Chiara Pomare 1 &
  • Jeffrey Braithwaite 1  

BMC Health Services Research volume  20 , Article number:  1123 ( 2020 ) Cite this article

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Broken windows theory (BWT) proposes that visible signs of crime, disorder and anti-social behaviour – however minor – lead to further levels of crime, disorder and anti-social behaviour. While we acknowledge divisive and controversial policy developments that were based on BWT, theories of neighbourhood disorder have recently been proposed to have utility in healthcare, emphasising the potential negative effects of disorder on staff and patients, as well as the potential role of collective efficacy in mediating its effects. The aim of this study was to empirically examine the relationship between disorder, collective efficacy and outcome measures in hospital settings. We additionally sought to develop and validate a survey instrument for assessing BWT in hospital settings.

Cross-sectional survey of clinical and non-clinical staff from four major hospitals in Australia. The survey included the Disorder and Collective Efficacy Survey (DaCEs) (developed for the present study) and outcome measures: job satisfaction, burnout, and patient safety. Construct validity was evaluated by confirmatory factor analysis (CFA) and reliability was assessed by internal consistency. Structural equation modelling (SEM) was used to test a hypothesised model between disorder and patient safety and staff outcomes.

The present study found that both social and physical disorder were positively related to burnout, and negatively related to job satisfaction and patient safety. Further, we found support for the hypothesis that the relationship from social disorder to outcomes (burnout, job satisfaction, patient safety) was mediated by collective efficacy (social cohesion, willingness to intervene).

Conclusions

As one of the first studies to empirically test theories of neighbourhood disorder in healthcare, we found that a positive, orderly, productive culture is likely to lead to wellbeing for staff and the delivery of safer care for patients.

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A long tradition exists in criminology and social-psychology research on the concept of neighbourhood disorder and in what ways disorder relates to anti-social behaviour and poor outcomes [ 1 ] . Interest in neighbourhood disorder is readily apparent in Broken Window Theory (BWT) [ 2 ], as well as in alternative perspectives of disorder involving shared expectation and cohesion—more broadly known as collective efficacy [ 3 , 4 , 5 ]—that are consistent with social disorganisation theory. The current study draws from these various theories and insights into neighbourhood disorder and applies them to hospital settings. At this point, we must make clear our intentions in applying neighbourhood disorder theories to healthcare. It is perilous to expect theories of neighbourhood disorder can be perfectly replicable in an organisational setting, nor do we consider that all elements of the theories are applicable to hospital settings (such as the concept of fear) [ 6 ] . We particularly reject the flawed ramifications of these theories that saw victimisation and blame attributed to individual neighbourhood members. However, here, we consider that concepts from neighbourhood studies may have considerable promise to shed new light on the relationships between the physical and social environments of hospitals on the one hand, and the health, wellbeing and behaviour of staff and patients, on the other [ 7 ] . We begin by reviewing the history and evolution of these theories before considering their application to healthcare.

Broken windows: a theory of disorder in neighbourhoods

Broken windows theory (BWT), as a social-psychological theory of urban decline, was originally developed almost 40 years ago by Wilson and Kelling [ 2 ]. Proponents of this theory argue that both physical disorder (e.g., broken windows, graffiti, litter) and social disorder (e.g., vandalism, antisocial activities) provide important environmental cues to the kinds of negative actions that are normalised and tolerated in an area, fuelling further incivility and more serious crime. For example, signs of disorder can signal potential safety issues to residents of a neighbourhood, leading to their withdrawal from public spaces, and thereby a reduction in informal social control, further perpetuating the effects of disorder [ 2 ].

Defining disorder

Although debates have occurred in the literature as to what counts as disorder, it has usually been defined as representing “minor violations of social norms” ([ 8 ] p4923). Some researchers have made a distinction between physical and social disorder, with physical disorder relating to the overall appearance of an area and social disorder directly involving people [ 9 ]. Thinking about disorder in this way, neighbourhoods with high levels of physical disorder were defined as: noisy, dirty, and run-down; buildings are in disrepair or abandoned; and vandalism and graffiti are common [ 10 ]. On the other hand, signs of social disorder in neighbourhoods may include the presence of people hanging out on the streets, drinking, or taking drugs [ 10 ]. Researchers highlight the importance of measuring perceptions of physical and social disorder as separate factors [ 9 , 11 ] with recent studies finding differential impacts of the two types of disorder [ 12 ].

Rethinking disorder: the role of collective efficacy

The BWT originally proposed by Wilson and Kelling [ 2 ] suggested a causal relationship with disorder leading to crime, which had a significant bearing upon subsequent controversial policy developments, such as ‘zero-tolerance policing’ [ 13 ] and ‘stop-and-frisk’ programs [ 14 ]. Under this approach, police pay attention to every facet of the law, including minor offences, such as public drinking and vandalism, with the aim of preventing more serious crimes from occurring [ 13 ]. The level of support these policing strategies have received has been surprising, given that BWT has not received a commensurate amount of study to date, and the research on crime that does exist is equivocal [ 12 ]. In particular, there has been an ongoing debate in the academic literature over whether BWT posits a direct or indirect relationship between disorder and crime. Most prominently, Sampson and Raudenbush [ 4 ] reconsidered the claims of BWT and argued instead that physical and social disorder were not generally causal antecedents to more serious crimes. Consistent with social disorganisation theory [ 3 ], Sampson and Raudenbush [ 4 ] suggested that collective efficacy has a significant influence on criminality in neighbourhoods. They defined collective efficacy as “social cohesion among neighbours combined with their willingness to intervene on behalf of the common good” ([ 5 ] p918). Empirical results supported their conceptual ideas in that the positive relationship between disorder and crime was mediated by collective efficacy [ 4 ].

Other lines of research have found a direct association between disorder and crime even when controlling for collective efficacy (e.g., [ 15 ]). For example, Plank et al. [ 16 ] studied disorder and collective efficacy in a school setting. They found a robust association between both disorder and violence (i.e., crime) while controlling for collective efficacy. They concluded that “fixing broken windows and attending to the physical appearance of the school cannot alone guarantee productive teaching and learning, but ignoring them greatly increases the chances of a troubling downward spiral” ([ 16 ] p244). In summary, the results are mixed as to the extent that there is direct effect of disorder on crime or other poor outcomes, but the evidence clearly suggests that there is at least an indirect effect. The key problem is what people do with this information. There is no justification for blaming individuals or demonising groups or neighbourhoods for their behaviour. We do not in any way condone seriously erroneous and consequential victimisation of people or groups as a result of the application of BWT. But we do think this is an area worthy of study.

Applying broken windows theory to healthcare

Following recent interest in applying BWT to smaller, more circumscribed environments, such as workplaces [ 17 , 18 ], researchers have started to consider the application of BWT to healthcare settings [ 7 , 19 , 20 ]. There are several well-studied trends in health services research that support this application. Theories and studies of increasing popularity include: the normalisation of deviance [ 21 ], behavioural modelling in hand hygiene [ 22 ], hospital workplace violence [ 23 ], and the association between staff’s safe work practices and their perceiving their work area as cluttered and disorderly [ 24 ].

Disorder in hospitals may include negative deviations, trade-offs or workarounds that manifest continuously in complex, dynamic and time-pressured environments, which can contribute to poor staff outcomes [ 25 , 26 , 27 ]. While trade-offs and workarounds occur in every setting, and they may have many benefits including signalling productive flexibility and staff capacity for manoeuvring, they can also represent risk in healthcare. For example, some researchers have shown that small deviations such as violating recommended processes for use of local anaesthesia can be detrimental, potentially even leading to death [ 28 ]. In line with BWT logic, there is evidence to suggest that the physical hospital environment influences the health and wellbeing of staff and patients [ 29 ]. Similarly, evidence shows that social disorder (e.g., bullying, violence) can influence staff in healthcare organisations [ 23 , 30 ]. All of these examples highlight the potential negative perpetuating effects of disorder in healthcare organisations and how disorder may detrimentally affect patients, such as through poor patient safety outcomes (see Fig.  1 [ 7 ]). Despite the elevated interest in BWT, we could find no empirical study of disorder in hospitals, nor any examination of the role of collective efficacy on staff outcomes or patient safety.

figure 1

Proposed model of disorder in hospitals Source: Churruca, Ellis et al., 2018 [ 7 ]

Aims of the present study

The primary purpose of the present study is to empirically examine the relationship between hospital disorder and three key outcomes: staff burnout, staff job satisfaction, and patient safety. We also sought to address the contention in the literature regarding the role of collective efficacy (defined here as social cohesion among hospital staff and their willingness to intervene to address problems) between hospital disorder and outcomes. The first aim was to develop a short but valid and reliable survey instrument for measuring physical disorder, social disorder, social cohesion and willingness to intervene in hospital settings. Based on previous research, physical and social disorder were kept as separate constructs. We then sought to test the following three research questions:

Is there a significant association between hospital disorder (physical disorder, social disorder) and staff outcomes (burnout, job satisfaction)?

Is there a significant association between hospital disorder (physical disorder, social disorder) and patient safety?

What is the function of “collective efficacy” (social cohesion, willingness to intervene) in hospitals? Specifically, does staff collective efficacy mediate the relationship between disorder and outcomes? Figure  2 demonstrates the simplified hypothesised mediation model.

figure 2

Hypothesised mediation model

Participants and setting

The study employed a cross-sectional survey of staff from four major hospitals in Australia. All hospital sites were public hospitals in metropolitan areas with over 200 beds. The sites were selected based on the similarity in the types of services offered (e.g., emergency department, intensive care, surgical, medical, geriatric care) and that they were located within areas of varying relative socio-economic disadvantage [ 31 ]. All hospital staff were invited to participate in the study through an invitation sent to their work email address. The email included a link to an online version of the survey via Qualtrics [ 32 ].

Survey development

The Disorder and Collective Efficacy survey (DaCEs) for hospital staff was developed for the present study based on an extensive review of the BWT literature. An initial pool of items was formed to assess the hypothesised constructs of the DaCEs: Physical disorder (19 items), social disorder (13 items), and collective efficacy, represented by social cohesion (12 items) and willingness to intervene (10 items). Some of the items were adapted from existing scales [ 16 , 24 , 33 , 34 , 35 ], and others were purpose-developed by the research team (see Supplementary File  1 ). Items were modified to make them relevant to a hospital context. All items were answered on a five-point Likert scale (1 = strongly disagree to 5 = strongly agree). A panel of experts in healthcare ( n  = 10; hospital staff and researchers) reviewed and provided feedback on the wording of items mapping onto each of the hypothesised constructs and checked for possible misinterpretations of questions, instructions and response format. Minor adjustments were made to the initial item pool (see Supplementary File  1 ). The aim was then to refine the item pool to produce a survey that would be short enough to be completed by busy hospital workers, but which has satisfactory psychometric properties.

Staff outcomes

The survey included existing validated scales to measure staff burnout and job satisfaction. Burnout was measured through a 10-item version of the Maslach Burnout Inventory (MBI) [ 36 , 37 , 38 ]. Two subscales of burnout—emotional exhaustion and depersonalisation—were used for the current survey as the third subscale, personal accomplishment, was deemed less relevant to nonclinical staff. Burnout items were answered on a seven-point Likert scale (1 = strongly disagree to 7 = strongly agree). The job satisfaction section of the Job Diagnostic Survey (5 items) was selected to capture individual’s feelings about their job [ 39 ]. Job satisfaction items were answered on a five-point Likert scale (1 = strongly disagree to 5 = strongly agree).

Patient safety

An item taken from the Hospital Survey of Patient Safety Culture (HSOPSC) was used as an indicator of patient safety [ 40 ]. This item is an outcome measure for patient safety that asks staff to provide an overall patient safety grade for their hospital (1 = excellent to 5 = failing).

Data analysis

Participants missing more than 10% of survey data were excluded. Remaining missing values were imputed using the Expectation Maximisation (EM) Algorithm within SPSS, version 25 [ 41 ]. Some items were then reversed coded so that higher item-response scores indicated a greater extent of job satisfaction, burnout, disorder, willingness to intervene, and patient safety (See Supplementary File  1 for individual recoded items). Frequency distributions were calculated to test whether items violated the assumption of univariate normality (i.e., skewness index ≥3, kurtosis index ≥10). As a number of the items were skewed (i.e., skewness index ≥3), the chi-square significance value was corrected for bias using the Bollen-Stine bootstrapping method [ 42 ] based on 1000 bootstrapped samples.

Items were evaluated psychometrically via confirmatory factor analysis (CFA), using a two-stage process. First, to refine the initial item pool, four one-factor congeneric models (of physical disorder, social disorder, social cohesion and willingness to intervene items) were run using AMOS, version 25 [ 43 ]. Here, our analytic plan involved removing one item at a time from each model using the following strategy: (i) removing items with the lowest factor loadings while maintaining the theoretical content and meaning of the proposed construct; (ii) removing items as long as each construct contained at least four observed variables; and (iii) items were removed as long as the resulting model demonstrated an improved model fit [ 44 , 45 ]. Differences in model fit were assessed using the chi-square difference test [ 46 ]. Second, two two-factor models were used to assess the factor structure of items related to disorder (i.e., physical disorder, social disorder) and collective efficacy (i.e., social cohesion, willingness to intervene) using the reduced item sets. Each item was loaded on the one factor it purported to represent. Further item refinement was undertaken as required through inspection of factor loadings, standardised residuals and modification indices to reduce each scale to three or four items. Goodness-of-fit was assessed using the Tucker Lewis Index (TLI), Comparative Fit Index (CFI) and Root Mean Square Error of Approximation (RMSEAs), and chi-square, with significance value supplemented by the Bollen-Stine bootstrap test. The TLI and CFI yield values ranging from zero to 1.00, with values greater than .90 and .95 being indicative of acceptable and excellent fit to the data [ 47 ]. For RMSEAs, values less than .05 indicate good fit, and values as high as .08 represent reasonable errors of approximation in the population [ 48 ]. For the Bollen-Stine test, non-significant values indicate that the proposed model is correct. Reliability of each of the subscales was assessed through Cronbach’s alpha (using SPSS, version 25) and composite reliability (using AMOS, version 25).

The hypothesised mediation model (Fig.  2 ) was assessed using structural equation modelling (SEM) in AMOS, version 25 [ 43 ]. First, we tested the direct effects from disorder (physical and social) to each outcome (burnout, job satisfaction, patient safety), followed by the indirect effect from disorder to outcomes, through collective efficacy (social cohesion, willingness to intervene). A parametric bootstrapping approach was used to test mediation. Under the bootstrapping approach, indirect effects are of interest and based on bootstrapped standard errors (with 1000 draws) [ 49 , 50 ]. Model fit was evaluated using CFI, TLI, RMSEA, and chi-square.

Descriptive statistics, distribution, reliability and confirmatory factor analysis

Participants were 415 staff from four hospitals in Australia. Once participants with more than 10% of survey data missing were excluded, the remaining sample was reduced to 340. Of the 340 participants, most were female (77.5%), worked as a nurse (34.2%), and had been working in the same hospital for three or more years (76.1%). The characteristics of the survey respondents are presented in Table  1 .

Descriptive statistics and data pertaining to assumptions of normality for all items are presented in Supplementary File  1 . The vast majority of the social disorder, social cohesion and willingness to intervene items demonstrated a skewness index greater than three, while only three items demonstrated a kurtosis index greater than 10 (SD7, SD10, SC6). As a result, Bollen-Stine bootstrapping was conducted in order to improve accuracy when assessing parameter estimates and fit indices.

To refine the initial item pool, first four one-factor congeneric models were run for items designed to measure physical disorder, social disorder, social cohesion and willingness to intervene. Based on an examination of modification indices and standardised factor loadings, items were removed one at a time, until the four strongest items remained. As shown in Table  2 , the reduced four-item constructs demonstrated much improved model fit statistics relative to the full models with all items. Chi-squared difference tests for all four constructs were significant, indicating that the reduced item constructs were significantly better models. The results of the chi-squared difference tests were: Physical disorder, (χ 2 difference = 139, df = 18, p  < .001), social disorder (χ 2 difference = 680, df = 63, p  < .001), social cohesion (χ 2 difference = 302, df = 52, p  < .001), and willingness to intervene (χ 2 difference = 243, df = 33, p  < .001).

Two two-factor models of disorder (physical disorder, social disorder) and collective efficacy (social cohesion, willingness to intervene) were then tested through CFA each using eight of their respective items. Each item was loaded on the one factor it purported to represent. Where required, further item refinement was undertaken through inspection of factor loadings, standardised residuals and modification indices. The two-factor model of disorder, including four physical disorder items and four social disorder items produced an adequate fit to the data, χ 2 (19) = 54.06, TLI = .96, CFI = .97, RMSEA = .08, though the Bollen-Stine bootstrap was significant ( p  = .005). Inspection of the standardised factor loadings for items PD3 and SD3 suggested that their removal may improve model fit. The removal of these two items resulted in an improved model fit, χ2 (8) = 18.28, TLI = .979, CFI = .989, RMSEA = .062, and the Bollen-Stine bootstrap ( p  = .057). The standardised factor loadings for the six items remaining ranged from .71 to .90. The correlation between physical disorder and social disorder was low, but significant ( r  = .17, p  = .007). Next, a two-factor model of collective efficacy consisting of four social cohesion items and four willingness to intervene items were tested. This model produced an excellent fit to the data, χ2 (19) = 25.36, TLI = .99, CFI = 1.00, RMSEA = .06, and the Bollen-Stine bootstrap was not significant ( p  = .458). The standardised factor loadings for the six items ranged from .68 to .90, and the correlation between social cohesion and willingness to intervene was strong, r  = .69, p  < .001. The retained items from the two-factor models are presented in Table  3 , along with their factor loadings. Cronbach’s alpha and composite reliability for the final items is also shown in Table  3 , demonstrating that all four scales demonstrated acceptable levels of reliability.

Research question 1: is there a significant association between hospital disorder and staff outcomes?

In order to examine the relationship between hospital disorder and staff outcomes, four separate models were run (i.e., models were run separately for physical disorder and social disorder, each with burnout and job satisfaction as dependent variables). Findings are presented in Supplementary File  2 . The results showed that physical disorder was significantly associated with higher burnout (β = .26, p  < .001) and lower job satisfaction (β = −.40, p  < .001). Similarly, social disorder was significantly associated with higher burnout (β = .23, p  < .001) and lower job satisfaction (β = −.54, p  < .001).

Research question 2: is there a significant association between hospital disorder and patient safety?

Two separate models were run for physical disorder and social disorder (Supplementary File  2 ). Physical disorder was significantly associated with lower patient safety scores (β = −.15, p  = .008). Likewise, a greater extent of social disorder was significantly associated with lower levels of patient safety (β = −.26, p  < .001).

Research question 3: does staff collective efficacy mediate the relationship between disorder and outcomes?

We then tested three separate mediation models for each outcome measure where the relationship between disorder and outcomes was mediated by collective efficacy via bootstrapping. For burnout, the model fit the data well, χ2 (81) = 142.75, TLI = .97, CFI = .98, RMSEA = .05. The findings presented in Fig.  3 show that there were significant negative paths from: social disorder to social cohesion (β = −.45, p  = .003); social disorder to willingness to intervene (β = −.49, p  = .002); social cohesion to burnout (β = −.23, p  = .022); and willingness to intervene to burnout (β = −.33, p  = .004). However, the paths from physical disorder to social cohesion (β = −.11, p  = .077) and from physical disorder to willingness to intervene (β = −.04, p  = .466) were not significant. Alongside these parameters, there was a significant direct effect from physical disorder to burnout (β = .18, p  = .001), but not from social disorder to burnout (β = −.07, p  = .351). Importantly, bootstrapped analyses for indirect effects indicated a significant indirect path from social disorder to burnout via social cohesion and willingness to intervene (β = .26, p  = .001). However, the indirect path from physical disorder to burnout was not significant (β = .04, p  = .205).

figure 3

Model of disorder and burnout, mediated by collective efficacy

For job satisfaction, the model provided an adequate fit to the data, χ2 (125) = 274.69, TLI = .95, CFI = .96, RMSEA = .06 (Fig.  4 ). The findings show that there was a significant path from social cohesion to job satisfaction (β = .34, p  = .002) and from willingness to intervene to job satisfaction (β = .38, p  = .001). The direct effects from physical disorder to job satisfaction (β = −.06, p  = .233) and from social disorder to job satisfaction (β = −.04, p  = .575) were not significant. Bootstrapped analyses for indirect effects indicated a significant indirect path from social disorder to job satisfaction via social cohesion and willingness to intervene (β = −.34, p  = .001). However, the indirect path from physical disorder to burnout was not significant (β = −.05, p  = .171).

figure 4

Model of disorder and job satisfaction, mediated by collective efficacy

For patient safety, the model fit provided a satisfactory fit to the data, χ2 (81) = 171.26, TLI = .96, CFI = .97, RMSEA = .06. The findings are presented in Fig.  5 and show that there was a significant path from willingness to intervene to patient safety (β = .23, p  = .041). The path from social cohesion to patient safety just failed to reach significance (β = .20, p  = .057). The direct effects from physical disorder to patient safety (β = −.08, p  = .155) and from social disorder to patient safety (β = −.04, p  = .612) were not significant. The indirect effects indicated a significant indirect path from social disorder to patient safety via social cohesion and willingness to intervene (β = −.20, p  = .001). However, the indirect path from physical disorder to burnout was not significant (β = −.03, p  = .174).

figure 5

Model of disorder and patient safety, mediated by collective efficacy

BWT and related theories of neighbourhood disorder were used here as a novel way of studying the influence of hospital environment on staff outcomes and patient safety. In this study, we developed and validated a survey instrument of disorder and collective efficacy for hospital staff—the DaCEs. In response to our research questions, we found that both social and physical disorder were positively related to burnout and negatively related to job satisfaction and patient safety. This indicated that the greater the perceived disorder in hospitals the higher the burnout and lower job satisfaction in hospital staff, and lower ratings of patient safety. Although neighbourhood disorder theories are not perfectly applicable to a hospital setting, our findings are broadly analogous with previous neighbourhood research and suggest that while attending to the physical appearance of the hospital cannot alone guarantee better staff and patient outcomes, ignoring them can significantly increase the chances of poorer outcomes. The present study also found support for the contention that collective efficacy mediated the relationship between social disorder and outcomes (burnout, job satisfaction, patient safety), but not for physical disorder.

This study is one of the first to empirically evaluate neighbourhood disorder theories in healthcare. Consistent with the original BWT, we found that perceptions of social and physical disorder were associated with potential safety issues [ 2 ], in this case, low patient safety ratings in hospitals. Past research on neighbourhood disorder supports the association between perceived neighbourhood disorder and poor mental health [ 51 ], corresponding with the present study’s findings that hospital disorder was associated with low job satisfaction and high burnout. These findings shed light on the potential relationship between culture and disorder in hospitals. We recognise that BWT has received considerable criticism over the years [ 1 ], particularly in response to controversial policy developments that were based on the BWT perspective. At this point, we must make clear that we do not advocate such policies, and find them abhorrent. However, we do contend that it seems likely that disorder is a marker for a poorer workplace culture compared to a workplace that is perceived as more orderly by hospital staff. This represents further converging evidence that having a productive, functional, more orderly culture is good for both staff and patients and not having a collective, efficacious, productive, collaborative culture is not [ 52 ].

Consistent with previous research, our study findings demonstrate the differential effects of physical and social disorder on outcome measures [ 11 , 53 ]. While both types of disorder were found to be directly related to all outcomes, once collective efficacy was added to the model, the relationship between social disorder and each of the outcomes became non-significant. In summary, consistent with the assertions of Sampson and Raudenbush [ 4 ] and in concordance with social disorganisation theory, we found that the relationship between social disorder and all outcome measures was significantly mediated by collective efficacy; however, this was not the case for physical disorder. As for the potential reasons for these findings, from a research standpoint, social disorder and physical disorder are qualitatively different: neighbourhood social disorder has been described as “episodic behaviour” involving individuals “which only lasts for a limited amount of time”, whereas neighbourhood physical disorder instead refers to “the deterioration of urban landscapes” and “does not necessarily involve actors” ([ 53 ] p5). Similarly, in a hospital setting, physical disorder may be perceived by staff as a more stable and constant presence in the hospital environment. In other words, hospital staff may be “inoculated” ([ 12 ] p411) to the presence of physical disorder in the hospital environment, with collective efficacy being less likely to alter or affect the relationship between physical disorder and outcomes.

A further explanation as to why the relationship between social disorder and all three outcome measures were mediated by collective efficacy, but not for physical disorder, is because when social disorder manifests in hospitals (e.g., non-compliance, wasting time), healthcare staff must work together to ‘pick up the slack’ to avoid serious threats to the safety and quality of care delivered. For example, if certain staff are absent or late in a particular hospital ward, the rest of the staff in that ward must work together to negate the likelihood of patient safety issues. Working as a team to make up for the social disorder may prevent any one individual staff member experiencing burnout and low job satisfaction. Indeed, this is consistent with past research showing that collaboration in hospitals has a positive effect on staff and patient outcomes, including patient safety, burnout, and job satisfaction [ 54 ]. This differs to physical disorder (e.g., run-down hospital, vandalism) where it is not necessarily seen as the responsibility of hospital staff to work collaboratively and address this form of disorder. That is, while staff must work together to address issues of social disorder such as someone being absent or late, physical disorder is more likely to be seen to be needing to be dealt with on the organisational level. For example, a hospital being in need of repair needs intervention from the government, NHS Trust, Board of Governors or local health district which can provide the necessary resources to redevelop the infrastructure.

This study thereby contributes to the broader BWT and related neighbourhood disorder field as it highlights the importance of keeping social and physical disorder as separate constructs when assessing disorder. Further, this study highlights the importance of encouraging collective efficacy among hospital staff as it can act as a barrier between social disorder and poor staff outcomes and patient safety issues.

Strengths and limitations

A strength of this study was the development of an initial psychometric profile for the measure of disorder and collective efficacy for hospitals, with its psychometric properties being assessed across four hospital sites in Australia. As to limitations, the study was based on self-reports of staff and, as with all research of this kind, is reflective of the perceptions of the agents involved. We did not include patients’ self-reports or observational research. The data was collected at one time point and therefore cannot identify any causal influence of physical and social disorder on outcomes which would require longitudinal studies involving repeated sampling on the same set of study participants. The findings concerning patient safety would need to be replicated in view of the fact that only one item was used to assess patient safety and therefore the measure has unestablished reliability. The DaCEs also warrants further cross-validation of its factor structure, as the final items were selected on the basis of results from our four included hospitals, and may not be generalisable to all hospital systems. Optimally, CFA should be randomly divided into subgroups (calibration and validation samples) to validate and verify the factor structure of the tool [ 55 ]. However, the current study was limited by the relatively modest sample size, and further work would be needed to verify the validity of the tool.

As one of the first studies to empirically test theories of neighbourhood disorder in healthcare, we found that a positive, orderly, productive culture is likely to lead to wellbeing for staff and better safety for patients, and vice versa. This is a modified study of BWT and related theories in hospitals, and one of the few studies to assess associations between different forms of disorder, collective efficacy, and staff and patient outcomes. Our hypothesised mediation model was supported, showing that the relationship between social disorder and outcomes (job satisfaction, burnout, patient safety) was mediated by collective efficacy. Having established and tested the robustness of the model, we offer it for new applications and future studies on this topic and highlight the importance of studying physical and social disorder as separate constructs. This study demonstrates the potential benefits of encouraging collective efficacy among hospital staff as it can act as a barrier to poor staff wellbeing and patient safety issues when there is social disorder.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

  • Broken windows theory

Disorder and Collective Efficacy Survey

Confirmatory factor analysis

Structural equation modelling

Maslach Burnout Inventory

Hospital Survey of Patient Safety Culture

Expectation Maximisation

Tucker Lewis Index

Comparative Fit Index

Root Mean Square Error of Approximation

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Acknowledgements

The authors thank all hospital staff that participated in the survey.

This work is supported in part by National Health and Medical Research Council grants held by JB (APP9100002, APP1176620 and APP1135048). The funding body had no role in the design of the study and collection, analysis, and interpretation of data.

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LAE, KC, JCL and JB conceived the study. LAE, KC, JCL and CP designed the DaCEs and drafted the paper. LAE, YT and CP performed the analysis. All authors read and approved the final manuscript.

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Ellis, L.A., Churruca, K., Tran, Y. et al. An empirical application of “broken windows” and related theories in healthcare: examining disorder, patient safety, staff outcomes, and collective efficacy in hospitals. BMC Health Serv Res 20 , 1123 (2020). https://doi.org/10.1186/s12913-020-05974-0

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An empirical application of “broken windows” and related theories in healthcare: examining disorder, patient safety, staff outcomes, and collective efficacy in hospitals

Louise a. ellis.

Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia

Kate Churruca

Yvonne tran, janet c. long, chiara pomare, jeffrey braithwaite, associated data.

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Broken windows theory (BWT) proposes that visible signs of crime, disorder and anti-social behaviour – however minor – lead to further levels of crime, disorder and anti-social behaviour. While we acknowledge divisive and controversial policy developments that were based on BWT, theories of neighbourhood disorder have recently been proposed to have utility in healthcare, emphasising the potential negative effects of disorder on staff and patients, as well as the potential role of collective efficacy in mediating its effects. The aim of this study was to empirically examine the relationship between disorder, collective efficacy and outcome measures in hospital settings. We additionally sought to develop and validate a survey instrument for assessing BWT in hospital settings.

Cross-sectional survey of clinical and non-clinical staff from four major hospitals in Australia. The survey included the Disorder and Collective Efficacy Survey (DaCEs) (developed for the present study) and outcome measures: job satisfaction, burnout, and patient safety. Construct validity was evaluated by confirmatory factor analysis (CFA) and reliability was assessed by internal consistency. Structural equation modelling (SEM) was used to test a hypothesised model between disorder and patient safety and staff outcomes.

The present study found that both social and physical disorder were positively related to burnout, and negatively related to job satisfaction and patient safety. Further, we found support for the hypothesis that the relationship from social disorder to outcomes (burnout, job satisfaction, patient safety) was mediated by collective efficacy (social cohesion, willingness to intervene).

Conclusions

As one of the first studies to empirically test theories of neighbourhood disorder in healthcare, we found that a positive, orderly, productive culture is likely to lead to wellbeing for staff and the delivery of safer care for patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-020-05974-0.

A long tradition exists in criminology and social-psychology research on the concept of neighbourhood disorder and in what ways disorder relates to anti-social behaviour and poor outcomes [ 1 ] . Interest in neighbourhood disorder is readily apparent in Broken Window Theory (BWT) [ 2 ], as well as in alternative perspectives of disorder involving shared expectation and cohesion—more broadly known as collective efficacy [ 3 – 5 ]—that are consistent with social disorganisation theory. The current study draws from these various theories and insights into neighbourhood disorder and applies them to hospital settings. At this point, we must make clear our intentions in applying neighbourhood disorder theories to healthcare. It is perilous to expect theories of neighbourhood disorder can be perfectly replicable in an organisational setting, nor do we consider that all elements of the theories are applicable to hospital settings (such as the concept of fear) [ 6 ] . We particularly reject the flawed ramifications of these theories that saw victimisation and blame attributed to individual neighbourhood members. However, here, we consider that concepts from neighbourhood studies may have considerable promise to shed new light on the relationships between the physical and social environments of hospitals on the one hand, and the health, wellbeing and behaviour of staff and patients, on the other [ 7 ] . We begin by reviewing the history and evolution of these theories before considering their application to healthcare.

Broken windows: a theory of disorder in neighbourhoods

Broken windows theory (BWT), as a social-psychological theory of urban decline, was originally developed almost 40 years ago by Wilson and Kelling [ 2 ]. Proponents of this theory argue that both physical disorder (e.g., broken windows, graffiti, litter) and social disorder (e.g., vandalism, antisocial activities) provide important environmental cues to the kinds of negative actions that are normalised and tolerated in an area, fuelling further incivility and more serious crime. For example, signs of disorder can signal potential safety issues to residents of a neighbourhood, leading to their withdrawal from public spaces, and thereby a reduction in informal social control, further perpetuating the effects of disorder [ 2 ].

Defining disorder

Although debates have occurred in the literature as to what counts as disorder, it has usually been defined as representing “minor violations of social norms” ([ 8 ] p4923). Some researchers have made a distinction between physical and social disorder, with physical disorder relating to the overall appearance of an area and social disorder directly involving people [ 9 ]. Thinking about disorder in this way, neighbourhoods with high levels of physical disorder were defined as: noisy, dirty, and run-down; buildings are in disrepair or abandoned; and vandalism and graffiti are common [ 10 ]. On the other hand, signs of social disorder in neighbourhoods may include the presence of people hanging out on the streets, drinking, or taking drugs [ 10 ]. Researchers highlight the importance of measuring perceptions of physical and social disorder as separate factors [ 9 , 11 ] with recent studies finding differential impacts of the two types of disorder [ 12 ].

Rethinking disorder: the role of collective efficacy

The BWT originally proposed by Wilson and Kelling [ 2 ] suggested a causal relationship with disorder leading to crime, which had a significant bearing upon subsequent controversial policy developments, such as ‘zero-tolerance policing’ [ 13 ] and ‘stop-and-frisk’ programs [ 14 ]. Under this approach, police pay attention to every facet of the law, including minor offences, such as public drinking and vandalism, with the aim of preventing more serious crimes from occurring [ 13 ]. The level of support these policing strategies have received has been surprising, given that BWT has not received a commensurate amount of study to date, and the research on crime that does exist is equivocal [ 12 ]. In particular, there has been an ongoing debate in the academic literature over whether BWT posits a direct or indirect relationship between disorder and crime. Most prominently, Sampson and Raudenbush [ 4 ] reconsidered the claims of BWT and argued instead that physical and social disorder were not generally causal antecedents to more serious crimes. Consistent with social disorganisation theory [ 3 ], Sampson and Raudenbush [ 4 ] suggested that collective efficacy has a significant influence on criminality in neighbourhoods. They defined collective efficacy as “social cohesion among neighbours combined with their willingness to intervene on behalf of the common good” ([ 5 ] p918). Empirical results supported their conceptual ideas in that the positive relationship between disorder and crime was mediated by collective efficacy [ 4 ].

Other lines of research have found a direct association between disorder and crime even when controlling for collective efficacy (e.g., [ 15 ]). For example, Plank et al. [ 16 ] studied disorder and collective efficacy in a school setting. They found a robust association between both disorder and violence (i.e., crime) while controlling for collective efficacy. They concluded that “fixing broken windows and attending to the physical appearance of the school cannot alone guarantee productive teaching and learning, but ignoring them greatly increases the chances of a troubling downward spiral” ([ 16 ] p244). In summary, the results are mixed as to the extent that there is direct effect of disorder on crime or other poor outcomes, but the evidence clearly suggests that there is at least an indirect effect. The key problem is what people do with this information. There is no justification for blaming individuals or demonising groups or neighbourhoods for their behaviour. We do not in any way condone seriously erroneous and consequential victimisation of people or groups as a result of the application of BWT. But we do think this is an area worthy of study.

Applying broken windows theory to healthcare

Following recent interest in applying BWT to smaller, more circumscribed environments, such as workplaces [ 17 , 18 ], researchers have started to consider the application of BWT to healthcare settings [ 7 , 19 , 20 ]. There are several well-studied trends in health services research that support this application. Theories and studies of increasing popularity include: the normalisation of deviance [ 21 ], behavioural modelling in hand hygiene [ 22 ], hospital workplace violence [ 23 ], and the association between staff’s safe work practices and their perceiving their work area as cluttered and disorderly [ 24 ].

Disorder in hospitals may include negative deviations, trade-offs or workarounds that manifest continuously in complex, dynamic and time-pressured environments, which can contribute to poor staff outcomes [ 25 – 27 ]. While trade-offs and workarounds occur in every setting, and they may have many benefits including signalling productive flexibility and staff capacity for manoeuvring, they can also represent risk in healthcare. For example, some researchers have shown that small deviations such as violating recommended processes for use of local anaesthesia can be detrimental, potentially even leading to death [ 28 ]. In line with BWT logic, there is evidence to suggest that the physical hospital environment influences the health and wellbeing of staff and patients [ 29 ]. Similarly, evidence shows that social disorder (e.g., bullying, violence) can influence staff in healthcare organisations [ 23 , 30 ]. All of these examples highlight the potential negative perpetuating effects of disorder in healthcare organisations and how disorder may detrimentally affect patients, such as through poor patient safety outcomes (see Fig.  1 [ 7 ]). Despite the elevated interest in BWT, we could find no empirical study of disorder in hospitals, nor any examination of the role of collective efficacy on staff outcomes or patient safety.

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Proposed model of disorder in hospitals Source: Churruca, Ellis et al., 2018 [ 7 ]

Aims of the present study

The primary purpose of the present study is to empirically examine the relationship between hospital disorder and three key outcomes: staff burnout, staff job satisfaction, and patient safety. We also sought to address the contention in the literature regarding the role of collective efficacy (defined here as social cohesion among hospital staff and their willingness to intervene to address problems) between hospital disorder and outcomes. The first aim was to develop a short but valid and reliable survey instrument for measuring physical disorder, social disorder, social cohesion and willingness to intervene in hospital settings. Based on previous research, physical and social disorder were kept as separate constructs. We then sought to test the following three research questions:

  • Is there a significant association between hospital disorder (physical disorder, social disorder) and staff outcomes (burnout, job satisfaction)?
  • Is there a significant association between hospital disorder (physical disorder, social disorder) and patient safety?

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Hypothesised mediation model

Participants and setting

The study employed a cross-sectional survey of staff from four major hospitals in Australia. All hospital sites were public hospitals in metropolitan areas with over 200 beds. The sites were selected based on the similarity in the types of services offered (e.g., emergency department, intensive care, surgical, medical, geriatric care) and that they were located within areas of varying relative socio-economic disadvantage [ 31 ]. All hospital staff were invited to participate in the study through an invitation sent to their work email address. The email included a link to an online version of the survey via Qualtrics [ 32 ].

Survey development

The Disorder and Collective Efficacy survey (DaCEs) for hospital staff was developed for the present study based on an extensive review of the BWT literature. An initial pool of items was formed to assess the hypothesised constructs of the DaCEs: Physical disorder (19 items), social disorder (13 items), and collective efficacy, represented by social cohesion (12 items) and willingness to intervene (10 items). Some of the items were adapted from existing scales [ 16 , 24 , 33 – 35 ], and others were purpose-developed by the research team (see Supplementary File  1 ). Items were modified to make them relevant to a hospital context. All items were answered on a five-point Likert scale (1 = strongly disagree to 5 = strongly agree). A panel of experts in healthcare ( n  = 10; hospital staff and researchers) reviewed and provided feedback on the wording of items mapping onto each of the hypothesised constructs and checked for possible misinterpretations of questions, instructions and response format. Minor adjustments were made to the initial item pool (see Supplementary File  1 ). The aim was then to refine the item pool to produce a survey that would be short enough to be completed by busy hospital workers, but which has satisfactory psychometric properties.

Staff outcomes

The survey included existing validated scales to measure staff burnout and job satisfaction. Burnout was measured through a 10-item version of the Maslach Burnout Inventory (MBI) [ 36 – 38 ]. Two subscales of burnout—emotional exhaustion and depersonalisation—were used for the current survey as the third subscale, personal accomplishment, was deemed less relevant to nonclinical staff. Burnout items were answered on a seven-point Likert scale (1 = strongly disagree to 7 = strongly agree). The job satisfaction section of the Job Diagnostic Survey (5 items) was selected to capture individual’s feelings about their job [ 39 ]. Job satisfaction items were answered on a five-point Likert scale (1 = strongly disagree to 5 = strongly agree).

Patient safety

An item taken from the Hospital Survey of Patient Safety Culture (HSOPSC) was used as an indicator of patient safety [ 40 ]. This item is an outcome measure for patient safety that asks staff to provide an overall patient safety grade for their hospital (1 = excellent to 5 = failing).

Data analysis

Participants missing more than 10% of survey data were excluded. Remaining missing values were imputed using the Expectation Maximisation (EM) Algorithm within SPSS, version 25 [ 41 ]. Some items were then reversed coded so that higher item-response scores indicated a greater extent of job satisfaction, burnout, disorder, willingness to intervene, and patient safety (See Supplementary File  1 for individual recoded items). Frequency distributions were calculated to test whether items violated the assumption of univariate normality (i.e., skewness index ≥3, kurtosis index ≥10). As a number of the items were skewed (i.e., skewness index ≥3), the chi-square significance value was corrected for bias using the Bollen-Stine bootstrapping method [ 42 ] based on 1000 bootstrapped samples.

Items were evaluated psychometrically via confirmatory factor analysis (CFA), using a two-stage process. First, to refine the initial item pool, four one-factor congeneric models (of physical disorder, social disorder, social cohesion and willingness to intervene items) were run using AMOS, version 25 [ 43 ]. Here, our analytic plan involved removing one item at a time from each model using the following strategy: (i) removing items with the lowest factor loadings while maintaining the theoretical content and meaning of the proposed construct; (ii) removing items as long as each construct contained at least four observed variables; and (iii) items were removed as long as the resulting model demonstrated an improved model fit [ 44 , 45 ]. Differences in model fit were assessed using the chi-square difference test [ 46 ]. Second, two two-factor models were used to assess the factor structure of items related to disorder (i.e., physical disorder, social disorder) and collective efficacy (i.e., social cohesion, willingness to intervene) using the reduced item sets. Each item was loaded on the one factor it purported to represent. Further item refinement was undertaken as required through inspection of factor loadings, standardised residuals and modification indices to reduce each scale to three or four items. Goodness-of-fit was assessed using the Tucker Lewis Index (TLI), Comparative Fit Index (CFI) and Root Mean Square Error of Approximation (RMSEAs), and chi-square, with significance value supplemented by the Bollen-Stine bootstrap test. The TLI and CFI yield values ranging from zero to 1.00, with values greater than .90 and .95 being indicative of acceptable and excellent fit to the data [ 47 ]. For RMSEAs, values less than .05 indicate good fit, and values as high as .08 represent reasonable errors of approximation in the population [ 48 ]. For the Bollen-Stine test, non-significant values indicate that the proposed model is correct. Reliability of each of the subscales was assessed through Cronbach’s alpha (using SPSS, version 25) and composite reliability (using AMOS, version 25).

The hypothesised mediation model (Fig.  2 ) was assessed using structural equation modelling (SEM) in AMOS, version 25 [ 43 ]. First, we tested the direct effects from disorder (physical and social) to each outcome (burnout, job satisfaction, patient safety), followed by the indirect effect from disorder to outcomes, through collective efficacy (social cohesion, willingness to intervene). A parametric bootstrapping approach was used to test mediation. Under the bootstrapping approach, indirect effects are of interest and based on bootstrapped standard errors (with 1000 draws) [ 49 , 50 ]. Model fit was evaluated using CFI, TLI, RMSEA, and chi-square.

Descriptive statistics, distribution, reliability and confirmatory factor analysis

Participants were 415 staff from four hospitals in Australia. Once participants with more than 10% of survey data missing were excluded, the remaining sample was reduced to 340. Of the 340 participants, most were female (77.5%), worked as a nurse (34.2%), and had been working in the same hospital for three or more years (76.1%). The characteristics of the survey respondents are presented in Table  1 .

Characteristics of survey respondents ( n  = 340)

Note. Columns may not equal total N due to missing demographic responses

Descriptive statistics and data pertaining to assumptions of normality for all items are presented in Supplementary File  1 . The vast majority of the social disorder, social cohesion and willingness to intervene items demonstrated a skewness index greater than three, while only three items demonstrated a kurtosis index greater than 10 (SD7, SD10, SC6). As a result, Bollen-Stine bootstrapping was conducted in order to improve accuracy when assessing parameter estimates and fit indices.

To refine the initial item pool, first four one-factor congeneric models were run for items designed to measure physical disorder, social disorder, social cohesion and willingness to intervene. Based on an examination of modification indices and standardised factor loadings, items were removed one at a time, until the four strongest items remained. As shown in Table  2 , the reduced four-item constructs demonstrated much improved model fit statistics relative to the full models with all items. Chi-squared difference tests for all four constructs were significant, indicating that the reduced item constructs were significantly better models. The results of the chi-squared difference tests were: Physical disorder, (χ 2 difference = 139, df = 18, p  < .001), social disorder (χ 2 difference = 680, df = 63, p  < .001), social cohesion (χ 2 difference = 302, df = 52, p  < .001), and willingness to intervene (χ 2 difference = 243, df = 33, p  < .001).

Model fit for the one-factor congeneric models

Two two-factor models of disorder (physical disorder, social disorder) and collective efficacy (social cohesion, willingness to intervene) were then tested through CFA each using eight of their respective items. Each item was loaded on the one factor it purported to represent. Where required, further item refinement was undertaken through inspection of factor loadings, standardised residuals and modification indices. The two-factor model of disorder, including four physical disorder items and four social disorder items produced an adequate fit to the data, χ 2 (19) = 54.06, TLI = .96, CFI = .97, RMSEA = .08, though the Bollen-Stine bootstrap was significant ( p  = .005). Inspection of the standardised factor loadings for items PD3 and SD3 suggested that their removal may improve model fit. The removal of these two items resulted in an improved model fit, χ2 (8) = 18.28, TLI = .979, CFI = .989, RMSEA = .062, and the Bollen-Stine bootstrap ( p  = .057). The standardised factor loadings for the six items remaining ranged from .71 to .90. The correlation between physical disorder and social disorder was low, but significant ( r  = .17, p  = .007). Next, a two-factor model of collective efficacy consisting of four social cohesion items and four willingness to intervene items were tested. This model produced an excellent fit to the data, χ2 (19) = 25.36, TLI = .99, CFI = 1.00, RMSEA = .06, and the Bollen-Stine bootstrap was not significant ( p  = .458). The standardised factor loadings for the six items ranged from .68 to .90, and the correlation between social cohesion and willingness to intervene was strong, r  = .69, p  < .001. The retained items from the two-factor models are presented in Table  3 , along with their factor loadings. Cronbach’s alpha and composite reliability for the final items is also shown in Table  3 , demonstrating that all four scales demonstrated acceptable levels of reliability.

CFA results for reduced two factor models of disorder and collective efficacy

Research question 1: is there a significant association between hospital disorder and staff outcomes?

In order to examine the relationship between hospital disorder and staff outcomes, four separate models were run (i.e., models were run separately for physical disorder and social disorder, each with burnout and job satisfaction as dependent variables). Findings are presented in Supplementary File  2 . The results showed that physical disorder was significantly associated with higher burnout (β = .26, p  < .001) and lower job satisfaction (β = −.40, p  < .001). Similarly, social disorder was significantly associated with higher burnout (β = .23, p  < .001) and lower job satisfaction (β = −.54, p  < .001).

Research question 2: is there a significant association between hospital disorder and patient safety?

Two separate models were run for physical disorder and social disorder (Supplementary File  2 ). Physical disorder was significantly associated with lower patient safety scores (β = −.15, p  = .008). Likewise, a greater extent of social disorder was significantly associated with lower levels of patient safety (β = −.26, p  < .001).

Research question 3: does staff collective efficacy mediate the relationship between disorder and outcomes?

We then tested three separate mediation models for each outcome measure where the relationship between disorder and outcomes was mediated by collective efficacy via bootstrapping. For burnout, the model fit the data well, χ2 (81) = 142.75, TLI = .97, CFI = .98, RMSEA = .05. The findings presented in Fig.  3 show that there were significant negative paths from: social disorder to social cohesion (β = −.45, p  = .003); social disorder to willingness to intervene (β = −.49, p  = .002); social cohesion to burnout (β = −.23, p  = .022); and willingness to intervene to burnout (β = −.33, p  = .004). However, the paths from physical disorder to social cohesion (β = −.11, p  = .077) and from physical disorder to willingness to intervene (β = −.04, p  = .466) were not significant. Alongside these parameters, there was a significant direct effect from physical disorder to burnout (β = .18, p  = .001), but not from social disorder to burnout (β = −.07, p  = .351). Importantly, bootstrapped analyses for indirect effects indicated a significant indirect path from social disorder to burnout via social cohesion and willingness to intervene (β = .26, p  = .001). However, the indirect path from physical disorder to burnout was not significant (β = .04, p  = .205).

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Model of disorder and burnout, mediated by collective efficacy

For job satisfaction, the model provided an adequate fit to the data, χ2 (125) = 274.69, TLI = .95, CFI = .96, RMSEA = .06 (Fig.  4 ). The findings show that there was a significant path from social cohesion to job satisfaction (β = .34, p  = .002) and from willingness to intervene to job satisfaction (β = .38, p  = .001). The direct effects from physical disorder to job satisfaction (β = −.06, p  = .233) and from social disorder to job satisfaction (β = −.04, p  = .575) were not significant. Bootstrapped analyses for indirect effects indicated a significant indirect path from social disorder to job satisfaction via social cohesion and willingness to intervene (β = −.34, p  = .001). However, the indirect path from physical disorder to burnout was not significant (β = −.05, p  = .171).

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Model of disorder and job satisfaction, mediated by collective efficacy

For patient safety, the model fit provided a satisfactory fit to the data, χ2 (81) = 171.26, TLI = .96, CFI = .97, RMSEA = .06. The findings are presented in Fig.  5 and show that there was a significant path from willingness to intervene to patient safety (β = .23, p  = .041). The path from social cohesion to patient safety just failed to reach significance (β = .20, p  = .057). The direct effects from physical disorder to patient safety (β = −.08, p  = .155) and from social disorder to patient safety (β = −.04, p  = .612) were not significant. The indirect effects indicated a significant indirect path from social disorder to patient safety via social cohesion and willingness to intervene (β = −.20, p  = .001). However, the indirect path from physical disorder to burnout was not significant (β = −.03, p  = .174).

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Model of disorder and patient safety, mediated by collective efficacy

BWT and related theories of neighbourhood disorder were used here as a novel way of studying the influence of hospital environment on staff outcomes and patient safety. In this study, we developed and validated a survey instrument of disorder and collective efficacy for hospital staff—the DaCEs. In response to our research questions, we found that both social and physical disorder were positively related to burnout and negatively related to job satisfaction and patient safety. This indicated that the greater the perceived disorder in hospitals the higher the burnout and lower job satisfaction in hospital staff, and lower ratings of patient safety. Although neighbourhood disorder theories are not perfectly applicable to a hospital setting, our findings are broadly analogous with previous neighbourhood research and suggest that while attending to the physical appearance of the hospital cannot alone guarantee better staff and patient outcomes, ignoring them can significantly increase the chances of poorer outcomes. The present study also found support for the contention that collective efficacy mediated the relationship between social disorder and outcomes (burnout, job satisfaction, patient safety), but not for physical disorder.

This study is one of the first to empirically evaluate neighbourhood disorder theories in healthcare. Consistent with the original BWT, we found that perceptions of social and physical disorder were associated with potential safety issues [ 2 ], in this case, low patient safety ratings in hospitals. Past research on neighbourhood disorder supports the association between perceived neighbourhood disorder and poor mental health [ 51 ], corresponding with the present study’s findings that hospital disorder was associated with low job satisfaction and high burnout. These findings shed light on the potential relationship between culture and disorder in hospitals. We recognise that BWT has received considerable criticism over the years [ 1 ], particularly in response to controversial policy developments that were based on the BWT perspective. At this point, we must make clear that we do not advocate such policies, and find them abhorrent. However, we do contend that it seems likely that disorder is a marker for a poorer workplace culture compared to a workplace that is perceived as more orderly by hospital staff. This represents further converging evidence that having a productive, functional, more orderly culture is good for both staff and patients and not having a collective, efficacious, productive, collaborative culture is not [ 52 ].

Consistent with previous research, our study findings demonstrate the differential effects of physical and social disorder on outcome measures [ 11 , 53 ]. While both types of disorder were found to be directly related to all outcomes, once collective efficacy was added to the model, the relationship between social disorder and each of the outcomes became non-significant. In summary, consistent with the assertions of Sampson and Raudenbush [ 4 ] and in concordance with social disorganisation theory, we found that the relationship between social disorder and all outcome measures was significantly mediated by collective efficacy; however, this was not the case for physical disorder. As for the potential reasons for these findings, from a research standpoint, social disorder and physical disorder are qualitatively different: neighbourhood social disorder has been described as “episodic behaviour” involving individuals “which only lasts for a limited amount of time”, whereas neighbourhood physical disorder instead refers to “the deterioration of urban landscapes” and “does not necessarily involve actors” ([ 53 ] p5). Similarly, in a hospital setting, physical disorder may be perceived by staff as a more stable and constant presence in the hospital environment. In other words, hospital staff may be “inoculated” ([ 12 ] p411) to the presence of physical disorder in the hospital environment, with collective efficacy being less likely to alter or affect the relationship between physical disorder and outcomes.

A further explanation as to why the relationship between social disorder and all three outcome measures were mediated by collective efficacy, but not for physical disorder, is because when social disorder manifests in hospitals (e.g., non-compliance, wasting time), healthcare staff must work together to ‘pick up the slack’ to avoid serious threats to the safety and quality of care delivered. For example, if certain staff are absent or late in a particular hospital ward, the rest of the staff in that ward must work together to negate the likelihood of patient safety issues. Working as a team to make up for the social disorder may prevent any one individual staff member experiencing burnout and low job satisfaction. Indeed, this is consistent with past research showing that collaboration in hospitals has a positive effect on staff and patient outcomes, including patient safety, burnout, and job satisfaction [ 54 ]. This differs to physical disorder (e.g., run-down hospital, vandalism) where it is not necessarily seen as the responsibility of hospital staff to work collaboratively and address this form of disorder. That is, while staff must work together to address issues of social disorder such as someone being absent or late, physical disorder is more likely to be seen to be needing to be dealt with on the organisational level. For example, a hospital being in need of repair needs intervention from the government, NHS Trust, Board of Governors or local health district which can provide the necessary resources to redevelop the infrastructure.

This study thereby contributes to the broader BWT and related neighbourhood disorder field as it highlights the importance of keeping social and physical disorder as separate constructs when assessing disorder. Further, this study highlights the importance of encouraging collective efficacy among hospital staff as it can act as a barrier between social disorder and poor staff outcomes and patient safety issues.

Strengths and limitations

A strength of this study was the development of an initial psychometric profile for the measure of disorder and collective efficacy for hospitals, with its psychometric properties being assessed across four hospital sites in Australia. As to limitations, the study was based on self-reports of staff and, as with all research of this kind, is reflective of the perceptions of the agents involved. We did not include patients’ self-reports or observational research. The data was collected at one time point and therefore cannot identify any causal influence of physical and social disorder on outcomes which would require longitudinal studies involving repeated sampling on the same set of study participants. The findings concerning patient safety would need to be replicated in view of the fact that only one item was used to assess patient safety and therefore the measure has unestablished reliability. The DaCEs also warrants further cross-validation of its factor structure, as the final items were selected on the basis of results from our four included hospitals, and may not be generalisable to all hospital systems. Optimally, CFA should be randomly divided into subgroups (calibration and validation samples) to validate and verify the factor structure of the tool [ 55 ]. However, the current study was limited by the relatively modest sample size, and further work would be needed to verify the validity of the tool.

As one of the first studies to empirically test theories of neighbourhood disorder in healthcare, we found that a positive, orderly, productive culture is likely to lead to wellbeing for staff and better safety for patients, and vice versa. This is a modified study of BWT and related theories in hospitals, and one of the few studies to assess associations between different forms of disorder, collective efficacy, and staff and patient outcomes. Our hypothesised mediation model was supported, showing that the relationship between social disorder and outcomes (job satisfaction, burnout, patient safety) was mediated by collective efficacy. Having established and tested the robustness of the model, we offer it for new applications and future studies on this topic and highlight the importance of studying physical and social disorder as separate constructs. This study demonstrates the potential benefits of encouraging collective efficacy among hospital staff as it can act as a barrier to poor staff wellbeing and patient safety issues when there is social disorder.

Acknowledgements

The authors thank all hospital staff that participated in the survey.

Abbreviations

Authors’ contributions.

LAE, KC, JCL and JB conceived the study. LAE, KC, JCL and CP designed the DaCEs and drafted the paper. LAE, YT and CP performed the analysis. All authors read and approved the final manuscript.

This work is supported in part by National Health and Medical Research Council grants held by JB (APP9100002, APP1176620 and APP1135048). The funding body had no role in the design of the study and collection, analysis, and interpretation of data.

Availability of data and materials

Ethics approval and consent to participate.

The ethical conduct of this study was approved by South Eastern Sydney Local Health District (HREC ref. no: 16/363). Governance approvals to conduct the research were obtained for each site. Participation was voluntary and anonymous. Participants provided written consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Broken Windows Theory of Criminology

Charlotte Ruhl

Research Assistant & Psychology Graduate

BA (Hons) Psychology, Harvard University

Charlotte Ruhl, a psychology graduate from Harvard College, boasts over six years of research experience in clinical and social psychology. During her tenure at Harvard, she contributed to the Decision Science Lab, administering numerous studies in behavioral economics and social psychology.

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Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

On This Page:

The Broken Windows Theory of Criminology suggests that visible signs of disorder and neglect, such as broken windows or graffiti, can encourage further crime and anti-social behavior in an area, as they signal a lack of order and law enforcement.

Key Takeaways

  • The Broken Windows theory, first studied by Philip Zimbardo and introduced by George Kelling and James Wilson, holds that visible indicators of disorder, such as vandalism, loitering, and broken windows, invite criminal activity and should be prosecuted.
  • This form of policing has been tested in several real-world settings. It was heavily enforced in the mid-1990s under New York City mayor Rudy Giuliani, and Albuquerque, New Mexico, Lowell, Massachusetts, and the Netherlands later experimented with this theory.
  • Although initial research proved to be promising, this theory has been met with several criticisms. Specifically, many scholars point to the fact that there is no clear causal relationship between lack of order and crime. Rather, crime going down when order goes up is merely a coincidental correlation.
  • Additionally, this theory has opened the doors for racial and class bias, especially in the form of stop and frisk.

The United States has the largest prison population in the world and the highest per-capita incarceration rate. In 2016, 2.3 million people were incarcerated, despite a massive decline in both violent and property crimes (Morgan & Kena, 2019).

These statistics provide some insight into why crime regulation and mass incarceration are such hot topics today, and many scholars, lawyers, and politicians have devised theories and strategies to try to promote safety within society.

Broken Windows Theory

One such model is broken windows policing, which was first brought to light by American psychologist Philip Zimbardo (famous for his Stanford Prison Experiment) and further publicized by James Wilson and George Kelling. Since its inception, this theory has been both widely used and widely criticized.

What Is the Broken Windows Theory?

The broken windows theory states that any visible signs of crime and civil disorder, such as broken windows (hence, the name of the theory), vandalism, loitering, public drinking, jaywalking, and transportation fare evasion, create an urban environment that promotes even more crime and disorder (Wilson & Kelling, 1982).

As such, policing these misdemeanors will help create an ordered and lawful society in which all citizens feel safe and crime rates, including violent crime rates, are low.

Broken windows policing tries to regulate low-level crime to prevent widespread disorder from occurring. If these small crimes are greatly reduced, then neighborhoods will appear to be more cared for.

The hope is that if these visible displays of disorder and neglect are reduced, violent crimes might go down too, leading to an overall reduction in crime and an increase in public safety.

Broken Windows Theory

Source: Hinkle, J. C., & Weisburd, D. (2008). The irony of broken windows policing: A micro-place study of the relationship between disorder, focused police crackdowns and fear of crime. Journal of Criminal Justice, 36(6), 503-512.

Academics justify broken windows policing from a theoretical standpoint because of three specific factors that help explain why the state of the urban environment might affect crime levels:

  • social norms and conformity;
  • the presence or lack of routine monitoring;
  • social signaling and signal crime.

In a typical urban environment, social norms and monitoring are not clearly known. As a result, individuals will look for certain signs and signals that provide both insight into the social norms of the area as well as the risk of getting caught violating those norms.

Those who support the broken windows theory argue that one of those signals is the area’s general appearance. In other words, an ordered environment, one that is safe and has very little lawlessness, sends the message that this neighborhood is routinely monitored and criminal acts are not tolerated.

On the other hand, a disordered environment, one that is not as safe and contains visible acts of lawlessness (such as broken windows, graffiti, and litter), sends the message that this neighborhood is not routinely monitored and individuals would be much more likely to get away with committing a crime.

With a decreased likelihood of detection, individuals would be much more inclined to engage in criminal behavior, both violent and nonviolent, in this type of area.

As you might be able to tell, a major assumption that this theory makes is that an environment’s landscape communicates to its residents in some way.

For example, proponents of this theory would argue that a broken window signals to potential criminals that a community is unable to defend itself against an uptick in criminal activity. It is not the literal broken window that is a direct cause for concern, but more so the figurative meaning that is ascribed to this situation.

It symbolizes a vulnerable and disjointed community that cannot handle crime – opening the doors to all kinds of unwanted activity to occur.

In neighborhoods that do have a strong sense of social cohesion among their residents, these broken windows are fixed (both literally and figuratively), giving these areas a sense of control over their communities.

By fixing these windows, undesired individuals and behaviors are removed, allowing civilians to feel safer (Herbert & Brown, 2006).

However, in environments in which these broken windows are left unfixed, residents no longer see their communities as tight-knit, safe spaces and will avoid spending time in communal spaces (in parks, at local stores, on the street blocks) so as to avoid violent attacks from strangers.

Additionally, when these broken windows are not fixed, it also symbolizes a lack of informal social control. Informal social control refers to the actions that regulate behavior, such as conforming to social norms and intervening as a bystander when a crime is committed, that are independent of the law.

Informal social control is important to help reduce unruly behavior. Scholars argue that, under certain circumstances, informal social control is more effective than laws.

And some will even go so far as to say that nonresidential spaces, such as corner stores and businesses, have a responsibility to actually maintain this informal social control by way of constant surveillance and supervision.

One such scholar is Jane Jacobs, a Canadian-American author and journalist who believed sidewalks were a crucial vehicle for promoting public safety.

Jacobs can be considered one of the original pioneers of the broken windows theory. One of her most famous books, The Death and Life of Great American Cities, describes how local businesses and stores provide a necessary sense of having “eyes on the street,” which promotes safety and helps to regulate crime (Jacobs, 1961).

Although the idea that community involvement, from both residents and non-residents, can make a big difference in how safe a neighborhood is perceived to be, Wilson and Keeling argue that the police are the key to maintaining order.

As major proponents of broken windows policing, they hold that formal social control, in addition to informal social control, is crucial for actually regulating crime.

Although different people have different approaches to the implementation of broken windows (i.e., cleaning up the environment and informal social control vs. an increase in policing misdemeanor crimes), the end goal is the same: crime reduction.

This idea, which largely serves as the backbone of the broken windows theory, was first introduced by Philip Zimbardo.

Examples of Broken Windows Policing

1969: philip zimbardo’s introduction of broken windows in nyc and la.

In 1969, Stanford psychologist Philip Zimbardo ran a social experiment in which he abandoned two cars that had no license plates and the hoods up in very different locations.

The first was a predominantly poor, high-crime neighborhood in the Bronx, and the second was a fairly affluent area of Palo Alto, California. He then observed two very different outcomes.

  James-And-Karla-Murray-NYC-Untapped-Cities

After just ten minutes, the car in the Bronx was attacked and vandalized. A family first approached the vehicle and removed the radiator and battery. Within the first twenty-four hours after Zimbardo left the car, everything valuable had been stripped and removed from the car.

Afterward, random acts of destruction began – the windows were smashed, seats were ripped up, and the car began to serve as a playground for children in the community.

On the contrary, the car that was left in Palo Alto remained untouched for more than a week before Zimbardo eventually went up to it and smashed the vehicle with a sledgehammer.

Only after he had done this did other people join the destruction of the car (Zimbardo, 1969). Zimbardo concluded that something that is clearly abandoned and neglected can become a target for vandalism.

But Kelling and Wilson extended this finding when they introduced the concept of broken windows policing in the early 1980s.

This initial study cascaded into a body of research and policy that demonstrated how in areas such as the Bronx, where theft, destruction, and abandonment are more common, vandalism would occur much faster because there are no opposing forces to this type of behavior.

As a result, such forces, primarily the police, are needed to intervene and reduce these types of behavior and remove such indicators of disorder.

1982: Kelling and Wilson’s Follow-Up Article

Thirteen years after Zimbardo’s study was published, criminologists George Kelling and James Wilson published an article in The Atlantic that applied Zimbardo’s findings to entire communities.

Kelling argues that Zimbardo’s findings were not unique to the Bronx and Palo Alto areas. Rather, he claims that, regardless of the neighborhood, a ripple effect can occur once disorder begins as things get extremely out of hand and control becomes increasingly hard to maintain.

The article introduces the broader idea that now lies at the heart of the broken windows theory: a broken window, or other signs of disorder, such as loitering, graffiti, litter, or drug use, can send the message that a neighborhood is uncared for, sending an open invitation for crime to continue to occur, even violent crimes.

The solution, according to Kelling and Wilson and many other proponents of this theory, is to target these very low-level crimes, restore order to the neighborhood, and prevent more violent crimes from happening.

A strengthened and ordered community is equipped to fight and deter crime (because a sense of order creates the perception that crimes go easily detected). As such, it is necessary for police departments to focus on cleaning up the streets as opposed to putting all of their energy into fighting high-level crimes.

In addition to Zimbardo’s 1969 study, Kelling and Wilson’s article was also largely inspired by New Jersey’s “Safe and Clean Neighborhoods Program” that was implemented in the mid-1970s.

As part of the program, police officers were taken out of their patrol cars and were asked to patrol on foot. The aim of this approach was to make citizens feel more secure in their neighborhoods.

Although crime was not reduced as a result, residents took fewer steps to protect themselves from crime (such as locking their doors). Reducing fear is a huge goal of broken-windows policing.

As Kelling and Wilson state in their article, the fear of being bothered by disorderly people (such as drunks, rowdy teens, or loiterers) is enough to motivate them to withdraw from the community.

But if we can find a way to make people feel less fear (namely by reducing low-level crimes), then they will be more involved in their communities, creating a higher degree of informal social control and deterring all forms of criminal activity.

Although Kelling and Wilson’s article was largely theoretical, the practice of broken windows policing was implemented in the early 1990s under New York City Mayor Rudy Giuliani. And Kelling himself was there to play a crucial role.

Early 1990s: Bratton and Giuliani’s implementation in NYC

In 1985, the New York City Transit Authority hired George Kelling as a consultant, and he was also later hired by both the Boston and Los Angeles police departments to provide advice on the most effective method for policing (Fagan & Davies, 2000).

  Giulian Broken Window Theory NYC

Five years later, in 1990, William J. Bratton became the head of the New York City Transit Police. In his role, Bratton cracked down on fare evasion and implemented faster methods to process those who were arrested.

He attributed a lot of his decisions as head of the transit police to Kelling’s work. Bratton was just the first to begin to implement such measures, but once Rudy Giuliani was elected as mayor in 1993, tactics to reduce crime began to really take off (Vedantam et al., 2016).

Together, Giuliani and Bratton first focused on cleaning up the subway system, where Bratton’s area of expertise lay. They sent hundreds of police officers into subway stations throughout the city to catch anyone who was jumping the turnstiles and evading the fair.

And this was just the beginning.

All throughout the 90s, Giuliani increased misdemeanor arrests in all pockets of the city. They arrested numerous people for smoking marijuana in public, spraying graffiti on walls, selling cigarettes, and they shut down many of the city’s night spots for illegal dancing.

Conveniently, during this time, crime was also falling in the city and the murder rate was rapidly decreasing, earning Giuliani re-election in 1997 (Vedantam et al., 2016).

To further support the outpouring success of this new approach to regulating crime, George Kelling ran a follow-up study on the efficacy of broken windows policing and found that in neighborhoods where there was a stark increase in misdemeanor arrests (evidence of broken windows policing), there was also a sharp decline in crime (Kelling & Sousa, 2001).

Because this seemed like an incredibly successful mode, cities around the world began to adopt this approach.

Late 1990s: Albuquerque’s Safe Streets Program

In Albuquerque, New Mexico, a Safe Streets Program was implemented to deter and reduce unsafe driving and crime rates by increasing surveillance in these areas.

Specifically, the traffic enforcement program influenced saturation patrols (that operated over a large geographic area), sobriety checkpoints, follow-up patrols, and freeway speed enforcement.

Albuquerque’s Safe Streets Program

The effectiveness of this program was analyzed in a study done by the U.S. National Highway Traffic Safety Administration (Stuser, 2001).

Results demonstrated that both Part I crimes, including homicide, forcible rape, robbery, and theft, and Part II crimes, such as sex offenses, kidnapping, stolen property, and fraud, experienced a total decline of 5% during the 1996-1997 calendar year in which this program was implemented.

Additionally, this program resulted in a 9% decline in both robbery and burglary, a 10% decline in assault, a 17% decline in kidnapping, a 29% decline in homicide, and a 36% decline in arson.

With these promising statistics came a 14% increase in arrests. Thus, the researchers concluded that traffic enforcement programs can deter criminal activity. This approach was initially inspired by both Zimbardo’s and Kelling and Wilson’s work on broken windows and provides evidence that when policing and surveillance increase, crime rates go down.

2005: Lowell, Massachusetts

Back on the east coast, Harvard University and Suffolk University researchers worked with local police officers to pinpoint 34 different crime hotspots in Lowell, Massachusetts. In half of these areas, local police officers and authorities cleaned up trash from the streets, fixed streetlights, expanded aid for the homeless, and made more misdemeanor arrests.

There was no change made in the other half of the areas (Johnson, 2009).

The researchers found that in areas in which police service was changed, there was a 20% reduction in calls to the police. And because the researchers implemented different ways of changing the city’s landscape, from cleaning the physical environment to increasing arrests, they were able to compare the effectiveness of these various approaches.

Although many proponents of the broken windows theory argue that increasing policing and arrests is the solution to reducing crime, as the previous study in Albuquerque illustrates. Others insist that more arrests do not solve the problem but rather changing the physical landscape should be the desired means to an end.

And this is exactly what Brenda Bond of Suffolk University and Anthony Braga of Harvard Kennedy’s School of Government found. Cleaning up the physical environment was revealed to be very effective, misdemeanor arrests were less so, and increasing social services had no impact.

This study provided strong evidence for the effectiveness of the broken windows theory in reducing crime by decreasing disorder, specifically in the context of cleaning up the physical and visible neighborhood (Braga & Bond, 2008).

2007: Netherlands

The United States is not the only country that sought to implement the broken windows ideology. Beginning in 2007, researchers from the University of Groningen ran several studies that looked at whether existing visible disorder increased crimes such as theft and littering.

Similar to the Lowell experiment, where half of the areas were ordered and the other half disorders, Keizer and colleagues arranged several urban areas in two different ways at two different times. In one condition, the area was ordered, with an absence of graffiti and littering, but in the other condition, there was visible evidence for disorder.

The team found that in disorderly environments, people were much more likely to litter, take shortcuts through a fenced-off area, and take an envelope out of an open mailbox that was clearly labeled to contain five Euros (Keizer et al., 2008).

This study provides additional support for the effect perceived order can have on the likelihood of criminal activity. But this broken windows theory is not restricted to the criminal legal setting.

2008: Tokyo, Japan

The local government of Adachi Ward, Tokyo, which once had Tokyo’s highest crime rates, introduced the “Beautiful Windows Movement” in 2008 (Hino & Chronopoulos, 2021).

The intervention was twofold. The program, on one hand, drawing on the broken windows theory, promoted policing to prevent minor crimes and disorder. On the other hand, in partnership with citizen volunteers, the authorities launched a project to make Adachi Ward literally beautiful.

Following 11 years of implementation, the reduction in crime was undeniable. Felony had dropped from 122 in 2008 to 35 in 2019, burglary from 104 to 24, and bicycle theft from 93 to 45.

This Japanese case study seemed to further highlight the advantages associated with translating the broken widow theory into both aggressive policing and landscape altering.

Other Domains Relevant to Broken Windows

There are several other fields in which the broken windows theory is implicated. The first is real estate. Broken windows (and other similar signs of disorder) can indicate low real estate value, thus deterring investors (Hunt, 2015).

As such, some recommend that the real estate industry adopt the broken windows theory to increase value in an apartment, house, or even an entire neighborhood. They might increase in value by fixing windows and cleaning up the area (Harcourt & Ludwig, 2006).

Consequently, this might lead to gentrification – the process by which poorer urban landscapes are changed as wealthier individuals move in.

Although many would argue that this might help the economy and provide a safe area for people to live, this often displaces low-income families and prevents them from moving into areas they previously could not afford.

This is a very salient topic in the United States as many areas are becoming gentrified, and regardless of whether you support this process, it is important to understand how the real estate industry is directly connected to the broken windows theory.

Another area that broken windows are related to is education. Here, the broken windows theory is used to promote order in the classroom. In this setting, the students replace those who engage in criminal activity.

The idea is that students are signaled by disorder or others breaking classroom rules and take this as an open invitation to further contribute to the disorder.

As such, many schools rely on strict regulations such as punishing curse words and speaking out of turn, forcing strict dress and behavioral codes, and enforcing specific classroom etiquette.

Similar to the previous studies, from 2004 to 2006, Stephen Plank and colleagues conducted a study that measured the relationship between the physical appearance of mid-Atlantic schools and student behavior.

They determined that variables such as fear, social order, and informal social control were statistically significantly associated with the physical conditions of the school setting.

Thus, the researchers urged educators to tend to the school’s physical appearance to help promote a productive classroom environment in which students are less likely to propagate disordered behavior (Plank et al., 2009).

Despite there being a large body of research that seems to support the broken windows theory, this theory does not come without its stark criticisms, especially in the past few years.

Major Criticisms

At the turn of the 21st century, the rhetoric surrounding broken windows drastically shifted from praise to criticism. Scholars scrutinized conclusions that were drawn, questioned empirical methodologies, and feared that this theory was morphing into a vehicle for discrimination.

Misinterpreting the Relationship Between Disorder and Crime

A major criticism of this theory argues that it misinterprets the relationship between disorder and crime by drawing a causal chain between the two.

Instead, some researchers argue that a third factor, collective efficacy, or the cohesion among residents combined with shared expectations for the social control of public space, is the causal agent explaining crime rates (Sampson & Raudenbush, 1999).

A 2019 meta-analysis that looked at 300 studies revealed that disorder in a neighborhood does not directly cause its residents to commit more crimes (O’Brien et al., 2019).

The researchers examined studies that tested to what extent disorder led people to commit crimes, made them feel more fearful of crime in their neighborhoods, and affected their perceptions of their neighborhoods.

In addition to drawing out several methodological flaws in the hundreds of studies that were included in the analysis, O’Brien and colleagues found no evidence that the disorder and crime are causally linked.

Similarly, in 2003, David Thatcher published a paper in the Journal of Criminal Law and Criminology arguing that broken windows policing was not as effective as it appeared to be on the surface.

Crime rates dropping in areas such as New York City were not a direct result of this new law enforcement tactic. Those who believed this were simply conflating correlation and causality.

Rather, Thatcher claims, lower crime rates were the result of various other factors, none of which fell into the category of ramping up misdemeanor arrests (Thatcher, 2003).

In terms of the specific factors that were actually playing a role in the decrease in crime, some scholars point to the waning of the cocaine epidemic and strict enforcement of the Rockefeller drug laws that contributed to lower crime rates (Metcalf, 2006).

Other explanations include trends such as New York City’s economic boom in the late 1990s that helped directly contribute to the decrease of crime much more so than enacting the broken windows policy (Sridhar, 2006).

Additionally, cities that did not implement broken windows also saw a decrease in crime (Harcourt, 2009), and similarly, crime rates weren’t decreasing in other cities that adopted the broken windows policy (Sridhar, 2006).

Specifically, Bernard Harcourt and Jens Ludwig examined the Department of Housing and Urban Development program that placed inner-city project residents into housing in more orderly neighborhoods.

Contrary to the broken windows theory, which would predict that these tenants would now commit fewer crimes once relocated into more ordered neighborhoods, they found that these individuals continued to commit crimes at the same rate.

This study provides clear evidence why broken windows may not be the causal agent in crime reduction (Harcourt & Ludwig, 2006).

Falsely Assuming Why Crimes Are Committed

The broken windows theory also assumes that in more orderly neighborhoods, there is more informal social control. As a result, people understand that there is a greater likelihood of being caught committing a crime, so they shy away from engaging in such activity.

However, people don’t only commit crimes because of the perceived likelihood of detection. Rather, many individuals who commit crimes do so because of factors unrelated to or without considering the repercussions.

Poverty, social pressure, mental illness, and more are often driving factors that help explain why a person might commit a crime, especially a misdemeanor such as theft or loitering.

Resulting in Racial and Class Bias

One of the leading criticisms of the broken windows theory is that it leads to both racial and class bias. By giving the police broad discretion to define disorder and determine who engages in disorderly acts allows them to freely criminalize communities of color and groups that are socioeconomically disadvantaged (Roberts, 1998).

For example, Sampson and Raudenbush found that in two neighborhoods with equal amounts of graffiti and litter, people saw more disorder in neighborhoods with more African Americans.

The researchers found that individuals associate African Americans and other minority groups with concepts of crime and disorder more so than their white counterparts (Sampson & Raudenbush, 2004).

This can lead to unfair policing in areas that are predominantly people of color. In addition, those who suffer from financial instability and may be of minority status are more likely to commit crimes in the first place.

Thus, they are simply being punished for being poor as opposed to being given resources to assist them. Further, many acts that are actually legal but are deemed disorderly by police officers are targeted in public settings but aren’t targeted when the same acts are conducted in private settings.

As a result, those who don’t have access to private spaces, such as homeless people, are unnecessarily criminalized.

It follows then that by policing these small misdemeanors, or oftentimes actions that aren’t even crimes at all, police departments are fighting poverty crimes as opposed to fighting to provide individuals with the resources that will make crime no longer a necessity.

Morphing into Stop and Frisk

Stop and frisk, a brief non-intrusive police stop of a suspect is an extremely controversial approach to policing. But critics of the broken windows theory argue that it has morphed into this program.

With broken-windows policing, officers have too much discretion when determining who is engaging in criminal activity and will search people for drugs and weapons without probable cause.

However, this method is highly unsuccessful. In 2008, the police made nearly 250,000 stops in New York, but only one-fifteenth of one percent of those stops resulted in finding a gun (Vedantam et al., 2016).

And three years later, in 2011, more than 685,000 people were stopped in New York. Of those, nine out of ten were found to be completely innocent (Dunn & Shames, 2020).

Thus, not only does this give officers free reins to stop and frisk minority populations at disproportionately high levels, but it also is not effective in drawing out crime.

Although broken windows policing might seem effective from a theoretical perspective, major valid criticisms put the practical application of this theory into question.

Given its controversial nature, broken windows policing is not explicitly used today to regulate crime in most major cities. However, there are still traces of this theory that remain.

Cities such as Ferguson, Missouri, are heavily policed and the city issues thousands of warrants a year on broken window types of crimes – from parking infractions to traffic violations.

And the racial and class biases that result from such an approach to law enforcement have definitely not disappeared.

Crime regulation is not easy, but the broken windows theory provides an approach to reducing offenses and maintaining order in society.

What is the broken glass principle?

The broken glass principle, also known as the Broken Windows Theory, posits that visible signs of disorder, like broken glass, can foster further crime and anti-social behavior by signaling a lack of regulation and community care in an area.

How does social context affect crime according to the broken windows theory?

The Broken Windows Theory proposes that the social context, specifically visible signs of disorder like vandalism or littering, can encourage further crime.

It suggests that these signs indicate a lack of community control and care, which can foster a climate of disregard for laws and social norms, leading to more severe crimes over time.

How did broken windows theory change policing?

The Broken Windows Theory influenced policing by promoting proactive attention to minor crimes and maintaining urban environments.

It led to strategies like “zero-tolerance” or “quality-of-life” policing, focusing on reducing visible signs of disorder to prevent more serious crime.

Braga, A. A., & Bond, B. J. (2008). Policing crime and disorder hot spots: A randomized controlled trial. Criminology, 46(3), 577-607.

Dunn, C., & Shames, M. (2020). Stop-and-Frisk data . Retrieved from https://www.nyclu.org/en/stop-and-frisk-data

Fagan, J., & Davies, G. (2000). Street stops and broken windows: Terry, race, and disorder in New York City. Fordham Urb. LJ , 28, 457.

Harcourt, B. E. (2009). Illusion of order: The false promise of broken windows policing . Harvard University Press.

Harcourt, B. E., & Ludwig, J. (2006). Broken windows: New evidence from New York City and a five-city social experiment. U. Chi. L. Rev., 73 , 271.

Herbert, S., & Brown, E. (2006). Conceptions of space and crime in the punitive neoliberal city. Antipode, 38 (4), 755-777.

Hunt, B. (2015). “Broken Windows” theory can be applied to real estate regulation- Realty Times. Retrieved from https://realtytimes.com/agentnews/agentadvice/item/40700-20151208-broken-windws-theory-can-be-applied-to-real-estate-regulation

Jacobs, J. (1961). The Death and Life of Great American Cities . Vintage.

Johnson, C. Y. (2009). Breakthrough on “broken windows.” Boston Globe.

Keizer, K., Lindenberg, S., & Steg, L. (2008). The spreading of disorder. Science, 322 (5908), 1681-1685.

Kelling, G. L., & Sousa, W. H. (2001). Do police matter?: An analysis of the impact of new york city’s police reforms . CCI Center for Civic Innovation at the Manhattan Institute.

Metcalf, S. (2006). Rudy Giuliani, American president? Retrieved from https://slate.com/culture/2006/05/rudy-giuliani-american-president.html

Morgan, R. E., & Kena, G. (2019). Criminal victimization, 2018. Bureau of Justice Statistics , 253043.

O”Brien, D. T., Farrell, C., & Welsh, B. C. (2019). Looking through broken windows: The impact of neighborhood disorder on aggression and fear of crime is an artifact of research design. Annual Review of Criminology, 2 , 53-71.

Plank, S. B., Bradshaw, C. P., & Young, H. (2009). An application of “broken-windows” and related theories to the study of disorder, fear, and collective efficacy in schools. American Journal of Education, 115 (2), 227-247.

Roberts, D. E. (1998). Race, vagueness, and the social meaning of order-maintenance policing. J. Crim. L. & Criminology, 89 , 775.

Sampson, R. J., & Raudenbush, S. W. (1999). Systematic social observation of public spaces: A new look at disorder in urban neighborhoods. American Journal of Sociology, 105 (3), 603-651.

Sampson, R. J., & Raudenbush, S. W. (2004). Seeing disorder: Neighborhood stigma and the social construction of “broken windows”. Social psychology quarterly, 67 (4), 319-342.

Sridhar, C. R. (2006). Broken windows and zero tolerance: Policing urban crimes. Economic and Political Weekly , 1841-1843.

Stuster, J. (2001). Albuquerque police department’s Safe Streets program (No. DOT-HS-809-278). Anacapa Sciences, inc.

Thacher, D. (2003). Order maintenance reconsidered: Moving beyond strong causal reasoning. J. Crim. L. & Criminology, 94 , 381.

Vedantam, S., Benderev, C., Boyle, T., Klahr, R., Penman, M., & Schmidt, J. (2016). How a theory of crime and policing was born, and went terribly wrong . Retrieved from https://www.npr.org/2016/11/01/500104506/broken-windows-policing-and-the-origins-of-stop-and-frisk-and-how-it-went-wrong

Wilson, J. Q., & Kelling, G. L. (1982). Broken windows. Atlantic monthly, 249 (3), 29-38.

Zimbardo, P. G. (1969). The human choice: Individuation, reason, and order versus deindividuation, impulse, and chaos. In Nebraska symposium on motivation. University of Nebraska press.

Further Information

  • Wilson, J. Q., & Kelling, G. L. (1982). Broken windows. Atlantic monthly, 249(3), 29-38.
  • Fagan, J., & Davies, G. (2000). Street stops and broken windows: Terry, race, and disorder in New York City. Fordham Urb. LJ, 28, 457.
  • Fagan, J. A., Geller, A., Davies, G., & West, V. (2010). Street stops and broken windows revisited. In Race, ethnicity, and policing (pp. 309-348). New York University Press.

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Northeastern University researchers find little evidence for ‘broken windows theory,’ say neighborhood disorder doesn’t cause crime

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broken windows theory research paper

More than 35 years ago, researchers theorized that graffiti, abandoned buildings, panhandling, and other signs of disorder in neighborhoods create an environment that leads people to commit more crime.

In the “broken windows theory,” as it has come to be known, such characteristics convey the message that these places aren’t monitored and crime will go unpunished. The theory has led police to crack down on minor crimes with the idea that this will prevent more serious crimes, and inspired research on how disorder affects people’s health.

Now, Northeastern researchers say they have debunked the “broken windows theory.” In research published in the Annual Review of Criminology and in Social Science & Medicine , they have found that disorder in a neighborhood doesn’t cause people to break the law, commit more crimes, have a lower opinion of their neighborhoods, or participate in dangerous or unhealthy behavior.

“The body of evidence for the broken windows theory does not stand, in terms of how disorder impacts individuals,” said Daniel T. O’Brien , associate professor in the School of Public Policy and Urban Affairs and the School of Criminology and Criminal Justice at Northeastern.

The methodology behind the findings

O’Brien and his research colleagues— Brandon Welsh , a professor of criminology and criminal justice at Northeastern, and doctoral student Chelsea Farrell—conducted two studies. One, published in Annual Review of Criminology, focused on whether disorder affects crime. The other, published in Social Science & Medicine , focused on the impact of disorder on public health.

O’Brien outlined the findings of both studies in an article published in April by the Scholars Strategy Network , an organization that connects journalists, policymakers, and civic leaders with researchers.

They wanted to see if the “broken windows theory” holds up. They sought answers to two questions: Does disorder cause crime, and does it have an impact on public health?

The researchers discovered that disorder in a neighborhood does not cause its residents to commit more crime. They found “no consistent evidence that disorder induces higher levels of aggression or makes residents feel more negative toward the neighborhood,” they wrote in their paper in the Annual Review of Criminology .

They also did not find that these signs of physical and social disrepair discourage people from exercising outside or encourage people to engage in unprotected sex.

However, the researchers did find a connection between disorder and mental health. They found that people who live in neighborhoods with more graffiti, abandoned buildings, and other such attributes experience more mental health problems and are more likely to abuse drugs and alcohol. But they say that this greater likelihood to abuse drugs and alcohol is associated with mental health, and is not directly caused by disorder.

The “broken windows theory” was developed by criminologist George L. Kelling and political scientist James Q. Wilson, who wrote a 7,000-word article in The Atlantic in 1982 in which they argued that maintaining order and preventing crime go hand in hand. Kelling died on May 15 at the age of 83 .

O’Brien and his colleagues used a procedure called meta-analysis to conduct their research. This means that they searched online research databases to find studies to include in their research, tested and recorded the results of each study, and pooled all those results together in order to draw a conclusion about the “broken windows theory.”

The researchers analyzed nearly 300 studies that examined the effects of at least one element of neighborhood disorder (say, graffiti or public drunkenness) on at least one outcome at the individual level (say, committing a violent crime or using drugs).

They then tested the effect that disorder was found to have on residents in each study. In the crime study, they tested to what extent disorder led people to commit crime, made them more fearful of crime in their neighborhoods, and affected their perceptions of their neighborhoods. In the health study, they tested whether disorder affected whether people exercised outdoors, experienced mental health problems, or engaged in risky behavior, including abusing drugs and alcohol or having unprotected sex.

O’Brien says that his team took into account the research methods used in each study in order to assess whether its design led researchers to find more evidence for the “broken windows theory” than there actually was.

broken windows theory research paper

Dan O’Brien. Photo by Adam Glanzman/Northeastern University

The Northeastern researchers say that they found two widespread flaws in how past studies that found evidence for the broken windows theory were designed. These flaws, they say, led to conclusions that overstated the impact that elements of neighborhood disorder had on crime and health.

The first flaw, they say, is that many studies didn’t account for important variables, including the income levels of households in the neighborhoods that were analyzed. O’Brien says that past research has found that the more poverty there is in a neighborhood, the more crime and disorder occurs there. His team’s meta-analysis revealed that the studies that didn’t account for socio-economic status found a stronger connection between disorder and crime than those that did account for the income levels of residents.

The second flaw, the say, relates to how researchers measured the levels of disorder in neighborhoods. O’Brien says that many studies evaluated disorder by surveying residents who were asked to assess how well their neighborhoods are maintained and either whether they worried about crime or suffered from mental health problems.

O’Brien says that the results of these surveys can be unreliable because people’s perception of the disorder in their neighborhoods may be intertwined with their assessments of crime as well as how they describe their own mental or physical health. The studies in which residents were asked both of these questions yielded the strongest evidence in favor of the broken windows theory. But studies in which researchers visited the neighborhoods and observed signs of disorder for themselves found less evidence to support the theory.

‘There are other ways to think about disorder’

O’Brien says that his team’s findings have significant implications. He says that policing and public health strategies shouldn’t be based on the idea that disorder causes people to break the law or participate in dangerous or unhealthy behavior.

But he also says that disorder, if studied in a more precise way, can provide valuable insight into what’s happening in neighborhoods and inform public policy.

“There are other ways to think about disorder,” says O’Brien, who co-directs the Boston Area Research Initiative , which is based at Northeastern’s School of Public Policy and Urban Affairs. “It’s not to say we should look at neighborhoods and say, ‘You know, graffiti and abandoned buildings don’t matter.’ It’s that they matter, but they didn’t matter in a way that the broken windows theory claims that they do.”

For media inquiries , please contact Shannon Nargi at [email protected].

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  1. Broken Windows, Informal Social Control, and Crime: Assessing Causality in Empirical Studies

    Conceptual model of broken windows theory: disorder, social control, and crime. ... It has also spawned a number of studies of broken windows using similar research designs. Nevertheless, the paper has been subject to sharp criticism. Wicherts & Bakker (2014), in particular, argue that the study is fraught with methodological weaknesses, such ...

  2. An empirical application of "broken windows" and related theories in

    A long tradition exists in criminology and social-psychology research on the concept of neighbourhood disorder and in what ways disorder relates to anti-social behaviour and poor outcomes []. Interest in neighbourhood disorder is readily apparent in Broken Window Theory (BWT) [], as well as in alternative perspectives of disorder involving shared expectation and cohesion—more broadly known ...

  3. Broken (windows) theory: A meta-analysis of the evidence for the

    The criminological "broken windows" theory (BWT) has inspired public health researchers to test the impact of neighborhood disorder on an array of resident health behaviors and outcomes. This paper identifies and meta-analyzes the evidence for three mechanisms (pathways) by which neighborhood disorder is argued to impact health, accounting ...

  4. (PDF) Broken Window Effect

    The "broken windows" theory was proposed by James Q. Wilson and George L. Kelling in the year 1982 and used as metaphor for anti-social behavior and civil disorder Van et al. (2017). According to ...

  5. Reimagining Broken Windows: From Theory to Policy

    This article serves as a substantive introduction and guiding post for the journal's special issue on "Reimagining Broken Windows: From Theory to Policy." It describes the core concepts of the broken windows perspective, examines its theoretical underpinnings, and sets out priorities for future research and policy development.

  6. Looking Through Broken Windows: The Impact of Neighborhood ...

    We explore implications for theory, research, and policy. Suggested Citation: Suggested Citation O'Brien, Daniel T. and Farrell, Chelsea and Welsh, Brandon C., Looking Through Broken Windows: The Impact of Neighborhood Disorder on Aggression and Fear of Crime is an Artifact of Research Design (January 2019).

  7. Broken Windows: New Evidence from New York City and a Five-City Social

    Keywords: broken windows theory, broken windows policing, New York City, policing, zero-tolerance, MTO, Moving To Oppportunity, disorder and crime, ... Public Law & Legal Theory Research Paper Series. Subscribe to this free journal for more curated articles on this topic FOLLOWERS. 4,225. PAPERS. 838. This Journal is curated by: ...

  8. Broken Windows and Community Social Control: Evidence from a Study of

    SUBMIT PAPER. Journal of Research in Crime and Delinquency. Impact Factor: 3.2 / 5-Year Impact Factor: 4.0 . ... Broken windows theory identifies community social control as a central mechanism for controlling crime. In turn, controlling disorder is seen as the primary method that police or other government agents can use to strengthen ...

  9. Reimagining Broken Windows: From Theory to Policy

    It describes the core concepts of the broken windows perspective, examines its theoretical underpinnings, and sets out priorities for future research and policy development. Important advancements have been made in the intellectual development and programmatic application of the broken windows perspective over the last 30 years.

  10. Revisiting broken windows theory: A test of the mediation impact of

    Broken windows theory was translated from paper into policy quickly and without rigorous academic testing. ... The most notable gap in existing research is a lack of sufficient attention paid to the social processes that supposedly form the causal bridge from disorder to crime. Broken windows theory holds that disorder leads to a breakdown in ...

  11. Broken Windows Theory and Citizen Engagement in Crime Prevention

    Rather, this paper confines itself to an empirical investigation of the Broken Windows theory in relation to civic engagement directed toward public safety in the U.S. setting. 2 There has been a well-documented serious erosion in response rates to landline telephone surveys in general (Battaglia, Link, Frankel, Osborn, & Mokdad, Citation 2008 ).

  12. Broken Windows: New Evidence from New York City and a Five-City Social

    Bernard E. Harcourt & Jens Ludwig, "Broken Windows: New Evidence from New York City and a Five-City Social Experiment" (University of Chicago Public Law & Legal Theory Working Paper No. 93, 2005). This Working Paper is brought to you for free and open access by the Working Papers at Chicago Unbound. It has been accepted for inclusion in Public ...

  13. Broken Windows, Informal Social Control, and Crime: Assessing Causality

    An important criminological controversy concerns the proper causal relationships between disorder, informal social control, and crime. The broken windows thesis posits that neighborhood disorder increases crime directly and indirectly by undermining neighborhood informal social control. Theories of collective efficacy argue that the association between neighborhood disorder and crime is ...

  14. An empirical application of "broken windows" and related theories in

    Background. A long tradition exists in criminology and social-psychology research on the concept of neighbourhood disorder and in what ways disorder relates to anti-social behaviour and poor outcomes []. Interest in neighbourhood disorder is readily apparent in Broken Window Theory (BWT) [], as well as in alternative perspectives of disorder involving shared expectation and cohesion—more ...

  15. PDF Broken Windows: New Evidence from New York City and a Five-City Social

    more serious crime.1 The "broken windows" theory produced what many observers have called a revolution in policing and law enforce-ment.2 Today, the three most populous cities in the United States— New York, Chicago, and, most recently, Los Angeles—have all adopted at least some aspect of Wilson and Kelling's broken windows theory,

  16. Street Stops and Broken Windows: Terry, Race and Disorder in New ...

    Abstract. Patterns of "stop and frisk" activity by police across New York City neighborhoods reflect competing theories of aggressive policing. "Broken Windows" theory suggests that neighborhoods with greater concentrations of physical and social disorder should evidence higher stop and frisk activity, especially for "quality of life" crimes.

  17. Broken Windows Theory

    The broken windows theory originated from a 1982 Atlantic Monthly article of the same name written by James Q. Wilson and George Kelling. They postulated that broken windows and other unchecked social and physical disorder are direct antecedents to criminal behavior. The article led to the development of popular broken windows policing or zero-tolerance policing strategies that targeted minor ...

  18. Broken windows theory

    In criminology, the Broken Windows Theory states that visible signs of crime, antisocial behavior and civil disorder create an urban environment that encourages further crime and disorder, including serious crimes. The theory suggests that policing methods that target minor crimes, such as vandalism, loitering, public drinking and fare evasion, help to create an atmosphere of order and lawfulness.

  19. Broken Windows Theory of Policing (Wilson & Kelling)

    The Broken Windows theory, first studied by Philip Zimbardo and introduced by George Kelling and James Wilson, holds that visible indicators of disorder, such as vandalism, loitering, and broken windows, invite criminal activity and should be prosecuted. This form of policing has been tested in several real-world settings.

  20. Broken Windows Theory Research Papers

    The Broken Windows Theory puts forward the notion that, in time, small-scale disorders in the region transform into major crimes. These disorders could also hinder tourism activities by paving the way for the convenient condition of crime and creating fear of offense among prospective visitors.

  21. Broken windows, mediocre methods, and substandard statistics

    Broken windows theory states that cues of inappropriate behavior like litter or graffiti amplify norm-violating behavior. ... Meeker F. L. (1997). A comparison of table-littering behavior in two settings: A case for a contextual research strategy. Journal of Environmental Psychology, 17, 59 ... Fondazione Eni Enrico Mattei Working Paper No. 493 ...

  22. Researchers Find Little Evidence for 'Broken Windows Theory'

    The "broken windows theory" was developed by criminologist George L. Kelling and political scientist James Q. Wilson, who wrote a 7,000-word article in The Atlantic in 1982 in which they argued that maintaining order and preventing crime go hand in hand. Kelling died on May 15 at the age of 83.

  23. Broken Window Theory Research Papers

    The name Broken Windows Theory was derived from an experiment conducted by Philip Zimbardo (1969), in which an abandoned automobile was placed in a high crime neighborhood where it remained untouched for a week until part of it was smashed by a researcher. Within a few hours of the initial damage the car was destroyed.