DO HEALTH-CARE WORKPLACES AFFECT TREATMENT ENVIRONMENTS

Previous research has demonstrated that characteristics of the health care workplace influence staff outcomes such as morale and burnout, bu t the potential effect of health care workplaces on the treatment envi ronment has been little studied. Building on a model proposed by Schae fer and Moos (1993), we propose that the workplace factors of supervis ory work environment (e.g. support from supervisors, managerial contro l) and programme philosophical orientation (e.g. disease model of addi ction, psychosocial learning model of addiction) predict four treatmen t environment elements: patient autonomy, staff control, staff sensiti vity, and patient alienation. Multiple regression analysis of data dra wn from a survey (response rate = 86%) of 327 staff members at 15 Vete rans Affairs (VA) inpatient substance abuse treatment programmes revea led that greater managerial control over staff predicted greater patie nt alienation, lower staff sensitivity towards patients, and greater s taff control over patients. Stronger disease model programme orientati ons predicted less patient alienation and greater staff sensitivity, w hereas stronger psychosocial model programme orientations predicted le ss staff control. These results suggest that health care workplaces ma y influence treatment environments. Implications for further research and practice are discussed. (C) 1997 by John Wiley & Sons, Ltd.