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Management styles employed in the adult mental health service

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Achieving a healthy relationship between manager and employee may be challenging but it is necessary if employees are to feel supported and content. The examination of this relationship and whether there is a connection between its quality and the retention of mental health staff are the focus of this study.


VOL: 99, ISSUE: 09, PAGE NO: 34

Joe Nichols, MSc counselling psychology, MSc human resource management, RGN, RMN, is professional officer mental health and learning disability nursing, Nursing and Midwifery Council, London.

Achieving a healthy relationship between manager and employee may be challenging but it is necessary if employees are to feel supported and content. The examination of this relationship and whether there is a connection between its quality and the retention of mental health staff are the focus of this study.

An unhappy workplace is typically characterised by low motivation, high absenteeism and rapid staff turnover. It is common for managers not to realise the extent of the problem until it reaches epidemic proportions.

It makes sense for managers to try to understand why employees may want to leave before they actually do. One way of doing this to ask staff about what might influence, or has influenced, their decision to leave. Yet far too many employers do not ask; Yate (1991) suggests that only one in 20 organisations actually do.

Hutchinson and Mattice (2000) suggest that there are three qualities a health care organisation must have to attract and retain nurses:

- A good reputation and a good working environment;

- Strong management and quality leadership - nurses today want to work with supportive senior managers who encourage communication and demonstrate a commitment to the welfare of nurses;

- Well-defined employee roles and expectations - the organisation should strive to offer challenging work for which nurses can assume responsibility.

The traditional approach to retaining staff assumes that people are primarily motivated by money and that the work is inherently unpleasant - that the money earned is more important than the nature of the job. The human relations approach, on the other hand, assumes that the role of social processes in the workplace is the largest motivator of staff. The approach acknowledges that employees want to feel useful and that these social needs are more important than money. This theme was emphasised in our study - mental health nurses wanted to ‘nurse’ more than anything else.

Managers of mental health nurses must get involved in the core business with the staff doing the work. They must know what is going on. Perhaps the most practical of all management techniques is management by walking about - being present - although this is rarely practised by senior management teams.

Support in the workplace is unlikely to be met with a lot of resistance. However, mental health nurses may be reluctant to ask for help in organisations that are not empowered to encourage support as it could be seen as a sign of weakness. Providing or requesting support must be seen as a sign of maturity, not one of weakness. In many organisations, there needs to be a shift in culture.

A survey was conducted in what was then a locality of an inner city NHS trust that provided mental health care. The survey was conceptualised from the need to respond to increasing staff turnover. The research took a case study approach and was carried out in two distinct phases using quantitative and qualitative methodologies. A questionnaire was designed to examine mental health nurses’ views on management styles, level of job satisfaction and views on staff retention.

Research aims
The purpose of the study was to examine the management style of an organisation, and the relationship between management and staff, in order to identify factors contributing towards an undesired trend in increasing leaving rates. The study also sought to find out how satisfied staff were with their jobs and what other factors may contribute to their decision to leave the organisation in future. The research will be described generally as an examination of whether ‘visible’ management may affect the retention of mental health nurses.

Research design
The questionnaires were sent to 75 nurses: 4 female H grades, 9 male G grades, 11 female G grades, 6 male F grades, 7 female F grades, 20 male E grades and 18 female E grades. Of these 75 nurses, 20 were community nurses and the rest were ward-based.

- The quantitative phase

A questionnaire was devised and piloted. The amended questionnaire was issued to staff in May to be returned by June. The questionnaire asked staff about their attitude to particular aspects of working in the inner city service provider in question. Respondents were asked to tick the answer that most closely represented their feelings. Some questions used a four-point Likert-type scale (Likert, 1932).

- The qualitative phase

The Likert-scale questionnaire was used in places for ease of completion and to help with statistical analysis. However, this approach can frustrate some respondents who prefer to use words as well as tick-boxes. To accommodate such people, all respondents were able to add further comments at the end of each question and at the end of the questionnaire itself.

- Focus groups

Focus groups were completed over a two-month period before the substantive study. In gaining support from management colleagues, I had to be honest about the possible negative outcomes, as I felt that the survey could pose a threat to particular managers, as it may encourage criticism of an individual style. Through initial interviews and musings both by way of meeting with colleagues and discussing recruitment and retention issues, I came up with a number of broad theories:

- The turnover trends of mental health nurses in the service were significant;

- These trends appeared to relate to causes specific to the organisation, rather than to general conditions of the profession.

The trends were related to a number of factors, including local management and supervisory/support style, working conditions and lack of opportunities for development. The survey was piloted in one clinical area, a ward that would be included in the main study.

Data analysis
With a descriptive study such as this, the purpose of the analysis was to collect information so that some general conclusions could be reached. Each questionnaire was scrutinised by looking at each question separately, categories were constructed from statements in some cases, and comparisons were made where possible. This enabled themes to be identified and conclusions drawn.

Most of the mental health nurses approached had worked in the same trust for some years. They had been through numerous change initiatives and had been party to a host of different management styles. Most of the respondents were junior nurses. This will need to be taken into consideration when interpreting the findings as it could be argued that more junior staff might be more ‘distant’ from managers and so may have an unfair picture of them.

A high number of respondents were much more interested in doing a job well than in being recognised by management as doing so, or being rewarded financially. Equally, most respondents stated that they received the most support from their colleagues, and relationships with colleagues were very important.

Most staff appeared to be attracted to the trust either after a positive experience as a student nurse in the locality, or because they chose to live in the area. Answers varied when respondents were asked about what they liked about working in the trust, but there seemed to be an emerging trend that the satisfaction with the work itself and relationships with colleagues were the most important elements of their work. Other ‘materialistic’ benefits such as pay and career development did not appear to be as important (see Box 1).

On viewing the tick-box responses in conjunction with the comments made, the overall management style was not received particularly positively. Some 47 per cent of respondents felt that the style was formal and autocratic. Many comments alluded to managers not really understanding the needs of the staff and the users of the service. Most of the managers had not evaluated their employees’ performance and most staff had not evaluated their manager’s performance.

In response to the question regarding the general visibility of management, the largest group of respondents saw a member of the management team less than once a month, with almost a quarter seeing someone at least once a week (see Box 1). All the comments pertained to the infrequency of visibility of management.

When asked about management appearing at people’s places of work without an ‘agenda’, the consensus was that staff would like managers to have more informal contact so that they could get a feel for the issues that staff thought were important. There was a suggestion that managers should become part of the team and do a shift for one day per month. It appeared that staff wanted more supportive managers who were better listeners and better communicators.

In response to the question asking what might affect a person’s decision to leave the trust in the future, the largest response group was those that might consider leaving if they felt undervalued. Some were concerned with safety, while others felt that the offer of better career prospects might entice them to leave.

In answer to the question about how trusts could retain staff better, 30 per cent felt that improved staffing levels might help to retain people (see Box 1). Career development and training opportunities were important to some, and there was as a particularly strong depth of feeling about being involved in decision-making.

Quite clearly staff were not impressed by the management styles adopted in the service. Managers were not visible enough and needed to integrate more with junior colleagues. Staff also felt undervalued.

Properly chosen values that are practised in the workplace can create an empowering atmosphere. A positive working environment such as this has to be managed by people who believe that others are willing and able to take more responsibility for their own work, want to do a good job, and gain as much satisfaction from achieving results as from financial reward. This can be a difficult model to promote because managers have to trust their employees and create effective relationships with them.

Management teams are key in identifying a culture, changing it or sustaining and promoting it. Creative and innovative managers can expect the same of their staff if these aptitudes become part of the organisation’s culture.

Demanding and unsupportive work environments lead to stressful personal lives of the employees, which result in lower productivity at work (Duff, 1998). One of the problems is that a manager’s frame of reference is different from that of their subordinates. ‘The manager is looking for efficiency, return on capital and trouble-free coordination of employee effort. While the subordinate is seeking an agreeable, dignified way of life within the confines of the employee contract’ (Torrington and Weightman, 1994).

These days few of us are either managers or subordinates as increasingly we are both. Every member of the management hierarchy has a boss or subordinate who can prevent or help the manager in getting things done. But there are ways that managers and subordinates can work together on a common goal. The principles of reaching this goal are quite simple. Managers should:

- Make sure their employees are happy;

- Develop their ‘soft’ skills, communications skills in particular;

- Be willing to mentor their employees. This responsibility includes imparting knowledge to them, investing time, and building relationships with them;

- Be decisive and guide their staff;

- Assume the responsibility of addressing and resolving conflicts. Managers should give constructive criticism, but this should be done gently so as to not offend the workers’ sensibilities.

The workplace must show tolerance and respect for people’s personal choices. Managers should learn to listen and provide employees with more chances to do their jobs in their own way, as well as cultivating the habit of excellence. Another important element of the staff survey process is the issue of outlining what action will be taken once the survey is completed. Staff may need reassurance as these surveys are too often ‘one-off’ exercises that are not followed-up.

Mental health nurses want to do a good job, not just turn up for work and go home again at the end of the shift. They are much more interested in gaining job satisfaction through helping to deliver quality care, than they are in the more materialistic elements of the job, such as improved pay and conditions.

Teamwork and support from colleagues is also very important to mental health nurses. It does appear that staff are looking for this same support to come from managers - some styles employed by the managers are generally not conducive to improving relations with employees.

Visibility and accessibility of management is not enough in itself. Mental health nurses want to be recognised, supported and feel involved in the development of the organisation. They appear to want an informal, regular physical presence from management, rather than a reactive style.

The solution is not difficult to achieve, and not costly. Supportive, visible managers who listen to staff and communicate effectively is not too onerous a task, and the foundations could already be there to build on. However, managers need staff to be open and reinforce a certain amount of constructive dissent from more junior nurses. Managers should encourage feedback about their own performance as well as regularly appraising their staff.

As a final note, this study should be placed in context. It has focused on management styles and the satisfaction of employees. Health care delivery in an inner city NHS trust is pressurised and in some places under-resourced. Staff are just as concerned about safety as they are about working relationships. However, building relationships with employees within the business, should yield more positive results.

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