R. Weir et al., THE EFFICACY AND EFFECTIVENESS OF PROCESS CONSULTATION IN IMPROVING STAFF MORALE AND ABSENTEEISM, Medical care, 35(4), 1997, pp. 334-353
OBJECTIVES. The purpose of this randomized controlled trial was to tes
t the efficacy and effectiveness of process consultation consisting of
a series of nurse manager-consultant problem-solving meetings for lea
dership development that would lead to their staff's improved morale,
quality of care, and reduced absenteeism. METHODS. Thirteen consenting
clinical inpatient units were stratified for four variables known to
affect outcome and were then randomly assigned to treatment and contro
l conditions. The nurse managers from the seven experimental units wer
e paired with outside nurse consultants from the McMaster University S
chool of Nursing (Hamilton, Ontario, Canada) in a cooperative form of
retraining in problem-solving through process consultation. Morale was
determined through measures of perceptions of the work environment, a
n attitude scale concerning work (alienation), a personality measure (
hardiness), and one of each scale for work satisfaction and for source
s of satisfaction and dissatisfaction. Demographic data and informatio
n regarding family life responsibilities were collected as well. Asses
sment of quality of care was determined by the frequency and type of i
ncident reports and by patients' perception of their satisfaction. A r
atio of absence hours to total paid hours of work was used to compare
experimental and control units' absenteeism rates. RESULTS. Experiment
al subjects reported a statistically significant improvement in the ch
aracteristics of their work setting and in the quality of working rela
tionships. The consultation process facilitated a perceived change in
the organizational context of the experimental hospital units with les
s centralization of authority and more clarity about expectation. Thes
e organizational changes were accompanied by improved working relation
ships and less alienation from work. There was no statistically signif
icant difference in absenteeism. However, a subanalysis of the units b
y ''dose'' of the intervention identified those who benefited from the
effects of the consultation. Subjects whose nurse managers participat
ed more actively in the consultation process accounted for the changes
in working relationships and perceived organizational changes. The ''
low-dose'' experimental subjects were more like the control subjects,
with the exception of absenteeism, for which they had higher rates. CO
NCLUSIONS. The findings of this study suggest that process consultatio
n can alter the staff's perceptions of the characteristics of the work
setting, can reverse negative attitudes (alienation), and can create
a more positive and supportive working environment (improved working r
elationship). However, the results suggest the need to target this typ
e of intervention to managers who have the personal resources to engag
e in self-evaluation and personal development and thus to participate
in the consultative process.