Evaluation of the impact of a consultation in a secure setting

Organisational consultation is widespread in the National Health Service (NHS), but little is known about its impact.

To evaluate the impact of a psychodynamically informed consultation to a high-security hospital ward.

This prospective study compared measures before and after the consultation with similarly timed measures on a comparison ward in the hospital, matched for patient characteristics, but not exposed to the consultation. The intention was to compare the consultation with 'treatment as usual', but the study became a comparison of interventions after a programme to facilitate staff-patient communication was instituted by management on the comparison ward. Measures included the Ward Atmosphere Scale (WAS) and an index of burnout. Interactions between staff and patients were observed and rated for content and quality.

Most scales on two of three dimensions of the WAS improved on both wards, as did the quality of staff-patient contact. Change at the levels of behaviour and attitude strengthens confidence that a shift occurred in a positive direction.

The overall importance of professional supportive attention to staff in such settings was established. Although there was little evidence here for a distinct advantage of one intervention style, the results were encouraging for the consultation, because ward atmosphere and staff-patient interaction were not a direct target for change. Further study is needed to test the possibility that specific interventions may carry specific advantage in other settings or with other patient groups. The nature and quality of institutional support for such research itself needs strengthening. In this case, the institutions' intention to assist was robust, but real understanding and/or sustained ability to facilitate it is lacking. This problem is hardly unique to this setting.