title: 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: BACKGROUND
  Health 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.
  
  
  METHODS
  All 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).
  
  
  RESULTS
  VOCALISE 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.
  
  
  CONCLUSIONS
  VOCALISE 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.
authors.affiliation: Department of Psychology, Institute of Psychiatry, King's College, PO77, Room 2,11, London Henry Wellcome Building, 16 De Crespigny Park, London, SE5 8AF, UK. caroline.laker@kcl.ac.uk.
authors.forename: Caroline
authors.initials: C
authors.lastname: Laker
authors.forename: Felicity
authors.initials: F
authors.lastname: Callard
authors.forename: Clare
authors.initials: C
authors.lastname: Flach
authors.forename: Paul
authors.initials: P
authors.lastname: Williams
authors.forename: Jane
authors.initials: J
authors.lastname: Sayer
authors.forename: Til
authors.initials: T
authors.lastname: Wykes
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D004651:Employment; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D007588:Job Satisfaction; D008131:London; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D010549:Personal Satisfaction; D011594:Psychometrics / Q000379:methods*; D036301:Qualitative Research; D055815:Young Adult