Can we improve the morale of staff working in psychiatric units? A systematic review

Abstract

Background: Those working in psychiatric units care for some of the most vulnerable and needy patients within health services, and suffer some of the highest levels of job dissatisfaction and burnout within healthcare workforce. Poor staff morale is bad for patient care and is economically wasteful. The same level of evidence of effectiveness and efficiency should be considered in workforce planning as is required in patient care. This has hitherto not occurred.

Aim: To examine the impact and cost effectiveness of strategies to improve staff morale and reduce “burnout” amongst staff working in psychiatric units.

Methods: We conducted a systematic review of robust evaluations of strategies designed to improve psychological wellbeing or the working experience of staff working in psychiatric units. We searched the following databases: EMBASE; MEDLINE; PsycINFO; CINAHL; Sociological Abstracts; HMIC; Management and Marketing Abstracts; Management Contents and Inside Conferences (all to 2004), and sought the following outcomes: Psychological wellbeing; Job satisfaction; staff burnout and stress; staff sickness and turnover; Direct and indirect costs. The following designs were included: Randomised Controlled Trails (RCTs); Controlled Clinical Trials (CCTs); Controlled Before and after studies (CBAs); and interrupted time series (ITSs). We conducted a narrative overview of key design features, endpoints and results.

Results: We identified eight evaluations of strategies to improve staff morale (3 RCTs; 3 CCTs and 2 CBAs). Educational interventions designed to enhance the skill and competency of staff were the most commonly evaluated, and showed positive impact on at least one outcome of interest. Psycho-social interventions that sought out members of staff who were experiencing emotional problems and offered work-based support and enhanced social support networks were positive in US healthcare settings, but had been incompletely implemented and evaluated in UK settings. Organisational interventions, such as a shift to continuous care and primary nursing also showed a potential to be effective in reducing sickness rates and improving job satisfaction.

Conclusions: There is substantial opportunity to design and implement interventions to improve the working experience of staff in psychiatric units. There is an onus to evaluate the longer term impact and cost effectiveness of these strategies. Unfortunately strategies are currently being implemented in the absence of any prospective evaluation.

Declaration of interest: The authors have no conflict of interest.

Keywords:

• Burnout
• stress
• mental health
• inpatient care