An Evaluation of a Pilot Self-Staffing Project in a Psychiatric Rehabilitation Unit
AUTHORS:
Monahan, M., Lynch, S., Douglas, D., Lawlor, A., Hughes. P., Nugent, M., Smyth, R., McGuinness, M., Whitehead, B., Neill, M., Sweeney, G., Griffin, S. & Burke, J.
Abstract
INTRODUCTION
Staffing in the healthcare sector has critical implications for allocation of resources, efficiency, effectiveness and the quality of patient care. A common approach used for the allocation of in the mental health services is ‘open rostering’ where staff may find themselves allocated to different units. This process places a burden on managers with frequently changing staff, diminished quality and continuity of care.
OBJECTIVES
This study examined the outcome of a change management project, implemented under the auspices of the Irish Health Service National Partnership Forum. The project followed the implementation of one type of flexible rostering known as ‘self-staffing’ in a psychiatric rehabilitation unit.
METHODOLOGY
The project was evaluated using a multi-method approach, with both quantitative and qualitative components. The quantitative perspective utilised descriptive statistical analysis in four areas, namely; staff shortfalls and vacancy management, reported incidents, short-term sick leave patterns, and quality of care over a four-year period. The qualitative component involved a two-tiered combined analysis approach using individual interviews and focus groups with staff and stakeholders in the project.
CONCLUSIONS
Findings from this study revealed that ‘self-staffing’ made a difference to the environment of care and staff satisfaction. There was an increase in staff morale, greater peer support, job satisfaction, greater continuity of client care and improved the quality of relationships and communication between staff. It was seen to have been most beneficial in the positive impact it had on the quality of interpersonal relationships and increased trust clients that had with staff. The system also enhanced the role of the clinical nurse manager creating a differentiation between managerial and clinical roles for staff and greatly facilitated the operation of the ‘key-worker’ system.
From a staff perspective, the process resulted in greater flexibility in their working life in the ability to plan for personal and professional commitments. The system allowed for easier management of vacancy management through earlier accessing of ‘bank nurses’ and negotiation of overtime with unit staff. This process permitted a reduction in vacant shifts and an increased willingness by staff to fill shortfalls when necessary.
RESULTS
The report concludes with recommendations for self-staffing and rehabilitative care, roster management, educational development, facilitation of quality of service in self-staffing areas, transferability of self-staffing to the wider area and the partnership process.
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