Factors affecting staff morale on inpatient mental health wards in England: a qualitative investigation

Jonathan Totman,Gillian Lewando Hundt,Moli Paul,Sonia Johnson,Elizabeth Wearn

doi:10.1186/1471-244x-11-68

Jonathan Totman, Gillian Lewando Hundt + Show 3 more

Open Access

https://doi.org/10.1186/1471-244x-11-68

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Abstract

BackgroundGood morale among staff on inpatient psychiatric wards is an important requirement for the maintenance of strong therapeutic alliances and positive patient experiences, and for the successful implementation of initiatives to improve care. More understanding is needed of mechanisms underlying good and poor morale.MethodWe conducted individual and group interviews with staff of a full range of disciplines and levels of seniority on seven NHS in-patient wards of varying types in England.ResultsInpatient staff feel sustained in their potentially stressful roles by mutual loyalty and trust within cohesive ward teams. Clear roles, supportive ward managers and well designed organisational procedures and structures maintain good morale. Perceived threats to good morale include staffing levels that are insufficient for staff to feel safe and able to spend time with patients, the high risk of violence, and lack of voice in the wider organisation.ConclusionsIncreasing employee voice, designing jobs so as to maximise autonomy within clear and well-structured operational protocols, promoting greater staff-patient contact and improving responses to violence may contribute more to inpatient staff morale than formal support mechanisms.

Highlights

Good morale among staff on inpatient psychiatric wards is an important requirement for the maintenance of strong therapeutic alliances and positive patient experiences, and for the successful implementation of initiatives to improve care
This study reported here is the qualitative component of the multiple methods National Inpatient Staff Morale study, commissioned by the National Institute of Health Research Service Delivery and Organisation programme [13,14]
For each ward participating in the quantitative study, we calculated a standardised mean morale score based on all the questionnaire measures of morale1 [13]. We used this to identify wards within the Trusts participating in the qualitative study that had mean morale scores in the top quartile or the bottom quartile of the 100 wards participating in the national study

Summary

Introduction

Good morale among staff on inpatient psychiatric wards is an important requirement for the maintenance of strong therapeutic alliances and positive patient experiences, and for the successful implementation of initiatives to improve care. More understanding is needed of mechanisms underlying good and poor morale. Psychiatric inpatient wards are potentially highly stressful places to work. Managers, clinicians and service users have all expressed concerns regarding the quality of inpatient care [2,3,4]. National audits report high rates of violence on psychiatric wards [5] and difficulties identified in a national review of acute wards [6] included high staff vacancy and sickness rates, lack of leadership from consultant psychiatrists, poor communication with community teams and limited availability of psychological treatments. Staff morale in the NHS is important in several respects.

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