Objectives. The purpose of this randomized controlled trial was to test the efficacy and effectiveness of process consultation consisting of a series of nurse manager-consultant problem-solving meetings for leadership 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 control conditions. The nurse managers from the seven experimental units were paired with outside nurse consultants from the McMaster University School 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, an attitude scale concerning work (alienation), a personality measure (hardiness), and one of each scale for work satisfaction and for sources of satisfaction and dissatisfaction. Demographic data and information regarding family life responsibilities were collected as well. Assessment of quality of care was determined by the frequency and type of incident reports and by patients' perception of their satisfaction. A ratio of absence hours to total paid hours of work was used to compare experimental and control units' absenteeism rates.
Results. Experimental subjects reported a statistically significant improvement in the characteristics of their work setting and in the quality of working relationships. The consultation process facilitated a perceived change in the organizational context of the experimental hospital units with less centralization of authority and more clarity about expectation. These organizational changes were accompanied by improved working relationships and less alienation from work. There was no statistically significant difference in absenteeism. However, a subanalysis of the units by "dose" of the intervention identified those who benefited from the effects of the consultation. Subjects whose nurse managers participated 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.
Conclusions. The findings of this study suggest that process consultation 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 relationship). However, the results suggest the need to target this type of intervention to managers who have the personal resources to engage in self-evaluation and personal development and thus to participate in the consultative process.
*From the School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
†From the Quality of Nursing Worklife Research Unit, McMaster University, Hamilton, Ontario, Canada.
‡From the Division of Nursing, Joseph Brant Memorial Hospital, Hamilton, Ontario, Canada.
§From the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
¶From the System-Linked Research Unit, McMaster University, Hamilton, Ontario, Canada.
∥From the Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada.
Supported by the Ontario Ministry of Health through the Hospital Incentive Fund, project number 28.
Address correspondence to: Dr. R. Weir, School of Nursing, Faculty of Health Sciences, McMaster University, HSC 3N28, 1200 Main St. West, Hamilton, Ont., Canada L8N 3Z5.