Rlchard Pettlnger

Stress-related problems

The hospital management has to deal with two major elements, each of which has the potential for organizational and individual stress and strain:

» developing strategic and operational management practice; and

» developing and improving staff relations.
Developing strategic and operational management practice

Broadmoor Hospital is run as a UK National Health Service hospital trust. Writing at the end of his first period of tenure in May 2000, the trust chairman, Terence Etherton, stated:

‘‘The past year has been extraordinarily busy for staff at all levels. I must begin by paying tribute to them. All, from the very top to the very bottom of the organization, have had to bear heavy workloads, to understand and implement new policies, often working long hours under conditions of great stress. Yet, despite all those pressures, demands, and dif ficulties, I feel excited and enthusiastic about the future of the hospital as the place for the care of the country ’s most damaged patients, and one in which our staff can find a sense of personal and professional ful fillment. The new management structure with three new directorates and the central support unit will be critical to the improvement of standards within the hospital. As well as this, the hospital has had to consider and deal with a succession of external initiatives and new policies over the past year. These include the final report of the external management review of the hospital, new

STRESS MANAGEMENT IN PRACTICE 85
security and child visiting directives, and the investigations and report into security at the three UK high security hospitals (the other two being Ashworth and Rampton). The treatment of high risk, personality disordered patients, the provision of social work services at high security hospitals, and the new requirement for ensuring adequate risk controls will also impact upon the hospital. In addition to responding to, and where appropriate, implementing these outside initiatives, time, resources, and effort within the hospital have been devoted to initiatives of our own. I have said publicly how very impressed I am with the range of training opportunities offered by, and within, the hospital. I am particularly proud of the hospital ’s workshops on working in a culturally sensitive service which all employees in the hospital, including myself, are required to attend. ’’²
The hospital also points to the following areas as key factors in the management of stress within this particular environment.

» Improving clinical services in accordance with both statutory and ‘‘best practice’’ requirements. Above all, there is the need to admit patients who are mentally ill and requiring inpatient treatment within units which have ‘‘the least restrictive environment appropriate ’’ for their needs. The hospital has a regular waiting list for men, most of whom are at present in prison. The hospital has established two committees – the Health Improvement Program Committee for patients’ health, and the Health in the Workplace Committee for staff.

» Improving information. The hospital recognizes that weaknesses in easily available clinical information in a common and usable form inhibit both the day-to-day management of patient care and the monitoring of service quality. The hospital urgently needs an improved clinical information system and is to develop a detailed specification by the end of the year 2001.

» Capability to ensure that clinical decision-making is evidence based. The problem here is that there is little formalized or stated good practice or evidence-based guidelines for mental health services in the UK compared with other specialties. The hospital does its best to follow guidance applicable to all health services, and to adapt this to