The challenge of change in acute mental health services: measuring staff perceptions of barriers to change and their relationship to job status and satisfaction using a new measure (VOCALISE)

Abstract

BackgroundHealth services are subject to frequent changes, yet there has been insufficient research to address how staff working within these services perceive the climate for implementation. Staff perceptions, particularly of barriers to change, may affect successful implementation and the resultant quality of care. This study measures staff perceptions of barriers to change in acute mental healthcare. We identify whether occupational status and job satisfaction are related to these perceptions, as this might indicate a target for intervention that could aid successful implementation. As there were no available instruments capturing staff perceptions of barriers to change, we created a new measure (VOCALISE) to assess this construct.MethodsAll nursing staff from acute in-patient settings in one large London mental health trust were eligible. Using a participatory method, a nurse researcher interviewed 32 staff to explore perceptions of barriers to change. This generated a measure through thematic analyses and staff feedback (N = 6). Psychometric testing was undertaken according to standard guidelines for measure development (N = 40, 42, 275). Random effects models were used to explore the associations between VOCALISE, occupational status, and job satisfaction (N = 125).ResultsVOCALISE was easy to understand and complete, and showed acceptable reliability and validity. The factor analysis revealed three underlying constructs: ‘confidence,’ ‘de-motivation’ and ‘powerlessness.’ Staff with negative perceptions of barriers to change held more junior positions, and had poorer job satisfaction. Qualitatively, nursing assistants expressed a greater sense of organisational unfairness in response to change.ConclusionsVOCALISE can be used to explore staff perceptions of implementation climate and to assess how staff attitudes shape the successful outcomes of planned changes. Negative perceptions were linked with poor job satisfaction and to those occupying more junior roles, indicating a negative climate for implementation in those groups. Staff from these groups may therefore need special attention prior to implementing changes in mental health settings.

Why is change a challenge in acute mental health wards? A cross‐sectional investigation of the relationships between burnout, occupational status and nurses’ perceptions of barriers to change

“…The psychometric properties of VOCALISE are described in another paper (Laker et al . ). A factor analysis of the 18‐item measure allowed three subscales to be developed, which include powerlessness (seven items), confidence (six Items) and demotivation (five items).…”

“…We developed the Views Of Change and Limitations in In‐patient Settings (VOCALISE) measure (Laker et al . ) using a method of stakeholder participation to allow ‘real setting’ items to emerge. The items describe emotional/psychological responses to change.…”

The side effects of service changes: exploring the longitudinal impact of participation in a randomised controlled trial (DOORWAYS) on staff perceptions of barriers to change.

“…Primary outcome measure: staff perceptions of barriers to Change As outlined in our previous papers [26,27], the 18 item Views Of Change and Limitations in Inpatient Settings (VOCALISE) measure [26] was developed with contributions from mental health nurses to capture their views of working in wards, and multiple causes of resistance to change. Some "barriers to change" identified below as original items from the VOCALISE measure [27]) reflected organisational difficulties:…”

Efectos de la fidelidad de la implementación sobre los resultados de una intervención preventiva en salud mental escolar: un análisis multinivel

“…Otra variable incorporada en el estudio de la FI, dada su influencia en el compromiso y la calidad de la intervención, es la satisfacción laboral de los implementadores (Faragher, 2005;Judge, Thoresen, Bono y Patton, 2001;Klassen y Chiu, 2010). En esta línea, se ha encontrado que la satisfacción laboral está asociada a actitudes respecto al cambio (Christl et al, 2010) y a percepciones respecto a las barreras de implementación (Laker et al, 2014).…”