Longitudinal evaluation of a programme for safety-culture change in a mental health service.

AIM To evaluate whether a two-part culture improvement program aimed at nurses in clinical and managerial positions in an inpatient mental health service was associated with culture-change, and safety-related behaviour and knowledge improvements. BACKGROUND Due to serious failings in the delivery of physiological care to mentally disordered inpatients it was deemed important that interventions be applied to improve service culture. METHODS A pre-test post-test study was conducted to evaluate change associated with a mandated intervention aimed at culture change. Nurses in clinical and managerial positions at all levels attended relevant sessions. All were invited to participate in evaluation measures. RESULTS N=241 nurses participated in the evaluation (n=137 and n=104 pre-test and post-test respectively). There was a small but significant change in organizational culture indicating greater adhocracy and less clan culture in the second survey period and a small decline in reported safety behaviour. Measures of safety culture, knowledge, and of emergency-related educational satisfaction were unchanged. CONCLUSION Only a small change in measured culture was associated with the program. IMPLICATIONS FOR NURSING MANAGEMENT Attempts to evaluate culture change need to align anticipated outcomes with appropriate outcomes measures. A mandated program of culture change had little tangible effect on the outcomes measured.