Elanor Lucy Webb, Jane L. Ireland and Michael Lewis
Staff in secure mental health-care settings face unique occupational challenges that may conflict with their personal or professional moral code. Initial research has established…
Abstract
Purpose
Staff in secure mental health-care settings face unique occupational challenges that may conflict with their personal or professional moral code. Initial research has established the presence of moral injury in this population, though insight into the specific sources and driving factors at the root of this syndrome is limited. The purpose of this study was to identify potentially morally injurious events and associated risk factors for secure mental healthcare staff.
Design/methodology/approach
To address this gap, a three-round expert Delphi survey was conducted to gain consensus on the conceptualisation, types and drivers of potentially morally injurious experiences (PMIEs) for secure mental health-care workers. Health-care professionals and academics in the field were recruited.
Findings
A high level of consensus (= 80%) was achieved on several sources of moral injury, which related to aspects of the health-care system, the secure context, relational dynamics and individual practices, behaviours and attitudes. Experts also agreed on several items relating to the definition of a PMIE, the factors driving the occurrence of PMIEs and the factors increasing risk for the subsequent development of moral injury.
Practical implications
The findings suggest that current definitions of PMIEs may, in isolation, be too narrow, prompting the need to attend to the broad range of PMIEs experienced by secure mental health-care staff. In addition, recommendations for the primary and secondary prevention of moral injury in secure mental health-care staff are offered, recognising the particular need for intervention at a systemic level.
Originality/value
To the best of the authors’ knowledge, this study is the first to consider the range of sources of moral injury faced by staff providing for people with complex forensic and mental health needs.
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Teray Johnson, Mark Newman and Sameh Shamroukh
The significance of organizational culture (OC) pervades all workplaces, extending even to health systems. While numerous studies have examined the perceptions of OC among nurses…
Abstract
Purpose
The significance of organizational culture (OC) pervades all workplaces, extending even to health systems. While numerous studies have examined the perceptions of OC among nurses and physicians, there is a notable gap in understanding the perspectives of non-patient-facing health system employees. This study aims to fill this void by investigating the perceptions and drivers of OC among non-patient-facing personnel within health systems.
Design/methodology/approach
This study employed a mixed-methods approach, starting with a 31-question survey disseminated to health system employees through trade organizations to capture diverse perspectives on OC. Subsequently, employees were invited to participate in semi-structured interviews. A total of 23 interviews were conducted to explore the underlying factors shaping employees’ perceptions of OC.
Findings
A total of 67 surveys were completed, with 61 used in the analysis. The results revealed a predominantly positive outlook, highlighting the significance of supportive leadership and involvement in decision-making processes. The qualitative analysis identified four key themes: effective communication and transparency, coordinated teamwork, supportive leadership and the impact of external factors like the coronavirus disease 2019 (COVID-19) pandemic.
Practical implications
Effective leadership should prioritize open communication, employee autonomy and involvement in decision-making. These strategies foster a culture of trust, accountability and engagement, enhancing employee morale and job satisfaction while promoting a collaborative and innovative work environment conducive to long-term success and growth.
Originality/value
This research examines the often-overlooked perspectives of non-patient-facing health system staff, providing valuable insights and strategies for leaders to improve OC and create a more positive, inclusive and supportive work environment.
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Teresa Corbett, Ninna Meier and Jackie Bridges
The study aims to explore how healthcare workers (HCWs) navigate and experience time when caring for older cancer patients living with other illnesses.
Abstract
Purpose
The study aims to explore how healthcare workers (HCWs) navigate and experience time when caring for older cancer patients living with other illnesses.
Design/methodology/approach
This paper presents findings from a qualitative study of how HCWs conceptualise and navigate the temporal aspects of delivering personalised care to older people living with multimorbidity. Building on research from organisation studies and the sociology of time, we interviewed 19 UK HCWs about their experiences of delivering care to this patient group.
Findings
Our findings illustrate how the delivery of personalised care contradicts contemporary models for healthcare delivery defined by efficiency and standardisation. We found that HCWs engage with time as both a valuable commodity to be rationed and prioritised within a constrained context and as a malleable resource for managing workload and overcoming “turbulence” in the system. However, participants in this study also shared how the simultaneous multiplicity and lack of time had a profoundly personal impact on them through the emotional toll associated with “time debt” and “lost” time.
Originality/value
This research presents a unique analysis of how time is conceptualised and navigated in contemporary healthcare, offering valuable insights for policy improvement. We conclude that personalised models of healthcare are incompatible with many current temporal structures of treatment trajectories and work-practices, by nature of being centred around the person and not the system of delivery.