Outcomes associated with skill mix interventions in acute mental health wards: a synthesis of evidence
| Pages | 25-33 |
| Published date | 01 November 2007 |
| DOI | https://doi.org/10.1108/17556228200700018 |
| Date | 01 November 2007 |
| Author | Sara Munro,John Baker |
| Subject Matter | Health & social care |
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Outcomes associated with skill mix
interventions in acute mental health
wards: a synthesis of evidence
Sara Munro, Practitioner Fellow, School of Nursing and Midwifery, University of Manchester
John Baker, Health Foundation Research Fellow/Lecturer, University of Manchester
The Journal of Mental Health Training, Education and Practice Volume 2 Issue 3 November 2007 © Pavilion Journals (Brighton) Ltd
Abstract
The costs associated with staffing acute mental
health wards is the largest expenditure in the
inpatient budget. Exploring skill mix and its impact
on outcomes, particularly service user outcomes
should be of interest to all stakeholders involved in
the commissioning, delivery and receipt of acute
mental health care. This paper describes the
findings of a literature and practice review of
initiatives undertaken to improve staffing and skill
mix, and their impact on service user outcomes.
The practice review was necessary due to the
paucity of published research in this area. Both
research and practice initiatives do not appear to be
driven by service user need. This results in a
restricted and service driven range of outcome
measures being used. The paper concludes by
proposing recommendations for future workforce
development in acute mental health settings.
Key words
acute mental health wards; staffing; skill mix;
patient outcomes; multidisciplinary team
Introduction and background
Acute mental health wards have been the subject of
criticism for many years (Clarke & Flanagan, 2003;
Sainsbury Centre for Mental Health, 2005, 2006, 1998;
Standing Nursing and Midwifery Advisory Committee,
1999, Hurst et al, 2002). These reports have focused on a
range of factors that have contributed to poor quality care
including the environment and hotel services, safety and
security, therapeutic and meaningful activity, and quality of
staff–service user interaction. A recurrent theme
underpinning many of these criticisms concerns the skill
mix of the multidisciplinary team (MDT). This also appears
to be an international issue (Hummelvoll & Severinsson,
2001, Smoot & Gonzales, 1995). Properly functioning
MDTs are considered key elements for treatment success in
acute mental health wards. More generally, appropriate skill
mix is crucial in determining the quality and cost of care
provided in all health settings (World Health Organization,
2000). For the purpose of this paper, skill mix is defined as,
‘A term used to describe the mix of posts, grades or occupations
in an organisation’ (Buchan & Dal Poz, 2002 p575).
The Nuffield Institute established a staffing database in
acute (non-mental health) settings, from which they
produced a report identifying different models of
determining skill mix and staffing levels (see Hurst et al,
2002). The Scottish Executive has conducted similar work
on ward staffing levels, which has included mental health
settings (NHS Scotland, 2004). The Audit Commission has
collated data on staffing levels and service user need on
over 300 adult acute mental health wards. This work is
provided on demand to trusts, but unfortunately is not
yet in the public domain.
Numbers of staff on duty is one element of skill mix
reported, and available data from a study in the North West
data shows that there are large variations between trusts in
staffing levels (nursing) per bed numbers. For example, a
19-bed ward in one trust has an establishment of 30.52
(wte) compared to a 24-bed ward with a staffing
establishment of 17.8 (wte) in another trust (Ryan et al,
2004). These databases highlight that staffing levels are
established both locally and historically. They tend to be
associated only with bed numbers and historical funding
arrangements with no apparent correlation between service
user needs, outcomes and staffing levels. For these reasons,
it can be hypothesised that skill mix, especially staff/service
user ratios in UK inpatient settings, have developed in an ad
hoc fashion and are based largely on historical factors.
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