Abstract
AimTo evaluate whether a two‐part culture improvement programme aimed at nurses in clinical and managerial positions in an inpatient mental health service was associated with culture change, and safety‐related behaviour and knowledge improvements.BackgroundDue to serious failings in the delivery of physiological care to mentally disordered inpatients, it was deemed important that interventions be applied to improve service culture.MethodsA pre‐test and post‐test study was conducted to evaluate change associated with a mandated intervention aimed at culture change. Nurses in clinical and managerial positions at all levels attended relevant sessions. All were invited to participate in evaluation measures.Results N = 241 nurses participated in the evaluation (n = 137 and n = 104, pre‐test and post‐test, respectively). There was a small but significant change in organisational culture indicating greater adhocracy and less clan culture in the second survey period and a small decline in reported safety behaviour. Measures of safety culture, knowledge and emergency‐related educational satisfaction were unchanged.ConclusionOnly a small change in measured culture was associated with the programme.Implications for Nursing ManagementAttempts to evaluate culture change need to align anticipated outcomes with appropriate outcome measures. A mandated programme of culture change had little tangible effect on the outcomes measured.
Highlights
Failure to recognize and appropriately respond to clinical physiological deterioration in patients admitted to mental health units is a relevant factor in a significant proportion of adverse events within these settings (Findlay et al, 2012)
Failings in physical health care in mental health settings can to some extent be understood in the context of prevalent organisational culture—typified by shared assumptions, shared ways of thinking and their visible manifestations (Mannion & Davies, 2018)—as much as in the context of expertise and technical skill
With particular reference to issues of culture and safety, the report recommended that New South Wales (NSW) ‘must establish and adopt an integral leadership development framework’ and ‘adopt a mental health safety programme informed by contemporary improvement science’
Summary
Failure to recognize and appropriately respond to clinical physiological deterioration in patients admitted to mental health units is a relevant factor in a significant proportion of adverse events within these settings (Findlay et al, 2012). The current study, conducted in Australia, was planned in the context of recommendations made in a 2017 New South Wales (NSW) government review of care in its mental health facilities (Wright 2017). Nurses on duty either failed to recognize, or wilfully ignored, her deterioration (Ross, 2018) and the Coronial inquest noted that she ‘did not have her physical health assessed, in regard to neuro observations’ (Coroners' Court of New South Wales, 2016). The resulting review included 19 recommendations across six domains: culture and leadership, patient safety, accountability and governance, workforce, consumer engagement, and the built and therapeutic environment (Wright 2017). With particular reference to issues of culture and safety, the report recommended that NSW ‘must establish and adopt an integral leadership development framework’ and ‘adopt a mental health safety programme informed by contemporary improvement science’
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
