Organisational effectiveness and personality disorder
| Date | 08 June 2015 |
| DOI | https://doi.org/10.1108/MHRJ-04-2014-0012 |
| Pages | 84-91 |
| Published date | 08 June 2015 |
| Author | Jane Yeandle,Liz Fawkes,Clare Carter,Chris Gordon,Elizabeth Challis |
| Subject Matter | Health & social care,Mental health |
Organisational effectiveness and
personality disorder
Jane Yeandle, Liz Fawkes, Clare Carter, Chris Gordon and Elizabeth Challis
Jane Yeandle is Head of
Division (Acting), at the Taunton
and West Somerset Division,
Somerset Partnership NHS
Foundation Trust,
Bridgwater, UK.
Liz Fawkes is Head of Service
at the Psychological Therapies
& Personality Disorder
Services, Somerset Partnership
NHS Foundation Trust,
Yeovil, UK.
Clare Carter is Senior Assistant
Psychologist, Chris Gordon
is Clinical Manager and
Elizabeth Challis is Assistant
Psychologist, all at the
Personality Disorder Service,
Somerset Partnership NHS
Foundation Trust, Yeovil, UK.
Abstract
Purpose –National treatment guidelines regarding Borderline Personality Disorder (BPD) (National Institute
for Health and Clinical Excellence, 2009) make a number of recommendations relating to system and cultural
treatment variables including: access to services, autonomy and choice, developing an optimistic and
trusting relationship and managing endings and transitions. The purpose of this paper is to look at a model
which could help organisational effectiveness across a range of service settings in relation to personality
disorder.
Design/methodology/approach –Explanation of why the McKinsey 7S organisational model
(Waterman et al., 1980) may be useful in assessing organisational effectiveness in relation to personality
disorder.
Findings –Cultural and organisational factors across a range of levels need to be aligned to allow for
effective service delivery. This is particularly important in working with this client group where strong emotional
reactions and subsequent organisational splits are common.
Practical implications –The application of this tool within clinical leadership and service development
would be particularly important for coherence within generalist (as opposed to specialist) settings.
Originality/value –To the authors’knowledge this analysis is unique as a review of NHS culture across
a range of settings and discussion of the implications for service delivery for patients with BPD.
Keywords Organizational effectiveness, Clinical leadership, Personality disorder, McKinsey 7S,
NHS culture, Service development
Paper type Viewpoint
Borderline personality disorder (BPD)
This paper describes principles of organisational effectiveness that could be used in relation to
different personality disorder types, but the focus being BPD due to the higher percentage of
people seen within the Trust with these characteristics.
BPD is a term used to describe a range of symptoms. Typically, patients may experience:
variable mood, intense anger, self-harm, impulsivity, feelings of emptiness, feelings of threat
and paranoia and poor self-image. The symptoms are defined as persistent, pervasive and
problematic. Furthermore, individuals’often experience relational difficulties and may have
a history of turbulent or unstable relationships.
Clinical guidelines and expert consensus recommend that the treatment of individuals with a
diagnosis of personality disorder should be rooted in trusting and open relationships (National
Institute for Mental Health England (NIMHE), 2003; Livesley, 2012). The literature also highlights
the difficulty many staff find in building and sustaining such relationships with what has
often been described as a “difficult client group”(Evans and Watson, 2010), particularly in
consideration of the apparent negative attitudes held by inpatient psychiatric nurses (Filer, 2005;
James and Cowman, 2007). Norton and Hinshelwood (1996) suggested that negativity from
health care professionals mainly resulted from a lack of understanding.
Received 17 April 2014
Revised 7 January 2015
10 March 2015
Accepted 31 March 2015
PAG E 84
j
MENTALHEALTH REVIEW JOURNAL
j
VOL. 20 NO. 2 2015, pp. 84-91, © Emerald Group Publishing Limited, ISSN 1361-9322 DOI 10.1108/MHRJ-04-2014-0012
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