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.