Article Summary: The relationship between leadership, teamworking, structure, burnout and attitude to patients on acute psychiatric wards (Nijman, Simpson, & Jones, 2011)

Bowers, Nijman, Simpson, and Jones (2011) examined the relationship between leadership, teamworking, structure, burnout and attitude towards patients on acute psychiatric wards. They looked at how these factors and the dynamics between these factors influence rates of conflict (which they specified included self-directed violence, irritability and aggression, inappropriate behavior, and nonadherence with treatment) and containment (which they specified included sedating medications, special levels of observation, manual restraints, and seclusion). They concluded by creating a model illustrating these factors and their influence on each other.


Bowers, Nijman, Simpson, and Jones (2011) highlighted that difficult behaviors of patients on an acute psychiatric unit create challenges for the staff who work on those units. Staff on these units strive to keep the patients, visitors, themselves, and other employees safe while conducting assessments and providing treatment to the patients. The article acknowledged that there are different conflict and containment rates between hospitals. The researchers conducted a number of studies in the UK and have previously found that many staff factors seemed to influence the conflict and containment rates. They listed examples including the staff’s psychological understanding of the patient’s behaviors, the staff’s moral commitments, how well the staff work together as a team, and the staff’s ability to provide structure on the unit (e.g. effective rules and routines). The findings suggested that the structure of the units was most closely related to the rates of conflicts and containments.


The researchers examined 136 acute psychiatric wards in the UK over a six month period during 2004-2005. They distributed five questionnaires including the attitude to personality disorder questionnaire (APDQ), ward atmosphere scale (WAS), team climate inventory (TCI), multifactor leadership questionnaire (MLQ), and Maslach burnout inventory (MBI). The study involved 6,661 completed questionnaires and the analysis was conducted by ward. Three analyses were completed. The first was a principal component analysis (PCA) where they looked for covariance to see if the number of factors could be reduced. The second involved the factors from the PCA being put into a structural equations modelling (SEM) specification search  to find a model that best incorporated all of the factors. The third analysis was a cluster analysis, which was conducted to place the wards into categorical groups. Finally, the researchers examined the relationship between each of the wards and their relationship to conflict and containment rates.


During the first analysis, they concluded that the number of factors could not be reduced and they continued to include all factors. The second analysis produced a model involving all of the factors. They represented the model in a diagram form. A summary of the model is as follows: leadership impacts teamwork, teamwork impacts structure, structure impacts burnout rates, and burnout influences attitudes towards difficult patients. They concluded that the teamwork among the staff members and the organization of the unit can be used to impact and prevent staff burnout and exhaustion. One of the discussion points noted that if reducing staff burnout is a goal, interventions may be beneficial if they focus on improving the structure on the unit. The researchers even suggested that increasing the structure on the unit may be more helpful for reducing burnout rates than improving the effectiveness of the team leader.


Bowers, L., Nijman, H., Simpson, A., & Jones, J. (2011). The relationship between leadership, teamworking, structure, burnout and attitude to patients on acute psychiatric wards. Social Psychiatry and Psychiatric Epidemiology, 46 143-148. doi:10.1007/s00127-010-0180-8


Brittany Best, MA
WKPIC Doctoral Intern

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