title: Factors affecting staff morale on inpatient mental health wards in England: a qualitative investigation.
abstract: BACKGROUND
  Good morale among staff on inpatient psychiatric wards is an important requirement for the maintenance of strong therapeutic alliances and positive patient experiences, and for the successful implementation of initiatives to improve care. More understanding is needed of mechanisms underlying good and poor morale.
  
  
  METHODS
  We conducted individual and group interviews with staff of a full range of disciplines and levels of seniority on seven NHS in-patient wards of varying types in England.
  
  
  RESULTS
  Inpatient staff feel sustained in their potentially stressful roles by mutual loyalty and trust within cohesive ward teams. Clear roles, supportive ward managers and well designed organisational procedures and structures maintain good morale. Perceived threats to good morale include staffing levels that are insufficient for staff to feel safe and able to spend time with patients, the high risk of violence, and lack of voice in the wider organisation.
  
  
  CONCLUSIONS
  Increasing employee voice, designing jobs so as to maximise autonomy within clear and well-structured operational protocols, promoting greater staff-patient contact and improving responses to violence may contribute more to inpatient staff morale than formal support mechanisms.
authors.affiliation: Research Department of Mental Health Sciences, University College London, Gower Street, London, WC1E 6BT, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Totman
authors.forename: Gillian Lewando
authors.initials: GL
authors.lastname: Hundt
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Wearn
authors.forename: Moli
authors.initials: M
authors.lastname: Paul
authors.forename: Sonia
authors.initials: S
authors.lastname: Johnson
mesh_terms: D000328:Adult; D004739:England; D005260:Female; D017144:Focus Groups; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009013:Morale; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data*