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Relational dynamics between patients and staff in forensic settings can be complicated and demanding for both sides. Reflective practice groups (RPGs) bring clinicians together to reflect on these dynamics. To date, evaluation of RPGs has lacked quantitative focus and a suitable quantitative tool. Therefore, a self-report tool was designed. This paper aims to pilot The Relational Aspects of CarE (TRACE) scale with clinicians in a high-secure hospital and investigate its psychometric properties.

A multi-professional sample of 80 clinicians were recruited, completing TRACE and attitudes to personality disorder questionnaire (APDQ). Exploratory factor analysis (EFA) determined factor structure and internal consistency of TRACE. A subset was selected to measure test–retest reliability. TRACE was cross-validated against the APDQ.

EFA found five factors underlying the 20 TRACE items: “awareness of common responses,” “discussing and normalising feelings;” “utilising feelings,” “wish to care” and “awareness of complicated affects.” This factor structure is complex, but items clustered logically to key areas originally used to generate items. Internal consistency (α = 0.66, 95% confidence interval (CI) = 0.55–0.76) demonstrated borderline acceptability. TRACE demonstrated good test–retest reliability (intra-class correlation = 0.94, 95% CI = 0.78–0.98) and face validity. TRACE indicated a slight negative correlation with APDQ. A larger data set is needed to substantiate these preliminary findings.

Early indications suggested TRACE was valid and reliable, suitable to measure the effectiveness of reflective practice.

The TRACE was a distinctive measure that filled a methodological gap in the literature.

The purpose of this paper is to investigate the impact of psychological case formulation meetings for staff in a secure forensic learning disability and autism service.

In total, 89 of the attendees completed a questionnaire prior to the formulation meeting and then another questionnaire following attendance at a formulation meeting.

The results indicate that staff found these to be a helpful, informative and a positive experience professionally and personally. The results suggest that the formulation meetings developed staffs’ psychological understanding about the patient and their problems, helped to increase their empathy towards the patient, increased consistency in the teams’ views, and that the staff felt listened to.

Psychological formulation meetings are established in the current service, and therefore this may be a contributing to factor to the lack of significant change found in some of the items. Therefore, it would be beneficial for future services to complete a service evaluation at a much earlier point of implementation, as this may impact the level of significance.

The findings of this service evaluation suggest that formulation is a beneficial and useful tool for teams and would be a helpful tool for psychologists to use in the clinical work with teams.

Staff must have an appreciation of legal and ethical issues associated with the people they care for, particularly when physical restraint to manage aggression or violence is being considered. This article examines legal and ethical issues related to the management of aggression and violence, and considers the inclusion of this material in training courses.

Patients' movement in mental health facilities is frequently compromised for reasons quite apart from real physical incompetence. Accessibility within mental healthcare facilities is a more complex issue than universal accessibility standards generically allow for. The purpose of this paper is to critically question the adequacy of universal design aids as the main way to deal with accessibility in facilities for the adult mentally ill in the community.

Several community mental healthcare units (in both Great Britain and France) are reviewed and analysed while they are occupied and running. The focus of the study is on restrictions of movement and the use of universal accessibility devices. The data are part of a broader exploratory study of facilities for mental healthcare, which used empirical, comparative and user inclusive methods.

Mental health facilities are rarely designed for the model of care and staffing regimes which they will house. This discordance between the physical and organizational milieu inevitably compromises accessibility, even though patients tend to be physically able. Outdoor access, vertical circulation and the accessibility of bathrooms are particularly affected.

Models of care, management and staffing requirements, therapeutic needs of patients and interpersonal relationships should be considered for accessibility during planning, in addition to traditional accessibility devices and design. Furthermore, more research is needed to address the ways that accessibility devices need to be altered to comply with the psychosocial elements.

This paper readdresses the traditional view of accessibility, suggesting the paradigm needs to be better developed and nuanced for mental healthcare facilities.

Mental health professionals working with patients with personality disorder are at risk of burnout. Burnout can adversely affect workforce retention and the delivery of high-quality care. The purpose of this paper is to investigate the impact of the three-day Knowledge and Understanding Framework (KUF) awareness-level personality disorder training on burnout, knowledge and attitudes in staff working in mental health settings.

A total of 253 mental health professionals attended the KUF training, delivered through a co-production model (i.e. co-delivered by a mental health professional and service user consultant with lived experience). Questionnaires were administered at pre- and post-training to assess changes in burnout symptoms and understanding, perceived capabilities and emotional reactions concerning personality disorder.

There were improvements in two burnout domains: decreases in emotional exhaustion (p = 0.009) and increases in personal accomplishment (p < 0.001) between pre-and post-training. Significant improvements were found in understanding, perceived capabilities and emotional reactions (p < 0.001).

This evaluation is limited by a lack of a control group and long-term follow-up. Further research is required to investigate the sustainability of reductions in burnout for mental health professionals attending training and supervision structures.

KUF training may contribute to reductions in the high levels of burnout often experienced amongst staff working in mental health settings and could form a part of a broader strategy focussing on continued supervision and opportunities to integrate learning into practice.

Gamification introduces game-like properties into routine service processes to make them more engaging for service employees and users alike. The purpose of this paper is to investigate the effects of gamification mechanics, or game design principles, on user engagement in gamified healthcare services.

Through observations, interviews and the study of desk materials, two cases of gamified healthcare services, each using different game mechanics, are analyzed.

Gamification mechanics produce four distinct experiential outcomes in patients: challenge, entertainment, social dynamics, and escapism. Patient engagement can be stimulated through these outcomes. However, to fully enjoy the benefits of gamified services, users are often expected to acquire and use new skills. The relative absence of these skills (or difficulties in acquiring them), depending on users’ medical predispositions and age, may defer or negatively moderate the positive effects of gamification on engagement. In the case of progressively decreasing capabilities (e.g. in the case of aging users or users with degenerative diseases, whose physical or mental disabilities may be emphasized by the mechanics), it is recommended that health professionals adapt the mechanics accordingly or search for alternative options to increase patient well-being.

The study was conducted in healthcare, and caution must be exercised in generalizing the findings to other domains. However, the finding that gamified service users’ disabilities - or the lack of required abilities – may negatively impact the encouraging or engaging effects of the use of gamification appears to be relatively universal.

This study contributes to service research, specifically in the healthcare domain, by providing insight into employees’ and users’ motivations for using gamified service processes, the experiential impact of gamification mechanics, the individual factors that influence users’ gamified experience and multiple forms of cognitive, emotional and behavioral engagement outcomes. A research agenda is developed.

This paper aims to examine the three dynamics of customer relationship management (CRM), namely, service quality (SQ), customer satisfaction (CS) and customer loyalty (CL) (long‐term relationship) in the healthcare sector. It specifically investigates the effects of physical environment quality (PEQ) and interaction quality (IQ) and significant components of SQ on outcome SQ dimensions, namely, CS and CL.

A total of 400 indoor patients from departments such as, general medicine, pediatrics, general surgery, gynecology, ENT and orthopedics were selected using proportionate stratified random sampling from May‐August 2007. Personal contact approach was used for contacting the respondents. Data validity and reliability were duly assessed using exploratory factor analysis. The data were then analyzed using structural equation modeling through AMOS.

Based on data analysis, the direct effect of CRM dynamics, i.e. PEQ and IQ on SQ and their ultimate effect on CS and CL is found to be significant. However, the model fit values came out poor as p (CMIN) (0.000), CMIN/DF (2,605.41), RMSEA (0.263), NFI (0.076), RFI (−0.066), IFI (0.078), TLI (−0.069) and CFI (0.074).

The cross‐sectional research design of the study does not offer nearly the same insight into the dynamics of CR as a longitudinal design study. The study analysed overall CS and CL as the major focus of the study was on the PEQ and IQ to understand impact of SQ on CRM outcomes and has ignored some antecedents that could help and explain customer perception more concretely. Further future studies could consider broader organization image typologies and measures in understanding CRM dynamics such as organizational excellence and customer value. This could become the future agenda for the upcoming studies.

PEQ needs to be improved by focusing on cleanliness of wards and toilets, peaceful atmosphere, supportive and additional facilities, clean drinking water, clean beddings, special services to the needy. IQ hospitals should organize training programmes to inculcate better attitudinal and behavioural skills to understand patients, giving them proper care, listening to and answering their queries. For better process quality, hospitals need to focus on effective administration functioning. The study concludes that there is need to improve CRM dynamics (PEQ and IQ) in the public healthcare to accomplish CRM objectives (CS and CL).

This study provides some important insights for CRM theory and practice. An understanding of SQ, CS and loyalty dynamics is a first step toward effective service management and the retention of customers in the long term. Three‐way interactions between the main effects of SQ, CS and loyalty yield additional insight into the relative importance of physical environment and IQ in customers' decision to be loyal, and that can provide a pave way for accomplishing CRM objectives.

Healthcare service quality in the USA has gained importance under value-based payment models. Providing feedback to front-line staff is a vital component of managing service performance, but complex organizational dynamics can prevent effective communication. This work explored the performance management of appointment desk staff at Mayo Clinic Arizona, identified barriers to effective management and sought to standardize the process for monitoring service performance.

Multiple data sources, including qualitative inquiry with 31 employees from the primary care and surgery departments, were used. The research was conducted in two phases – facilitated roundtable discussions with supervisors and semi-structured interviews with supervisors and staff six months after implementation of service standards. Participants were probed for attitudes about the service standards and supervisor feedback after implementation.

While all staff indicated a positive work environment, there was an unexpected and pervasive negative stigma surrounding individual feedback from one’s supervisor. Half the participants indicated there had been no individual feedback regarding the service standards from the supervisor. Presenting service standards in a simple, one-page format, signed by both supervisor and the patient service representative (PSR), was well received.

Combining rapid-cycle quality improvement methodology with qualitative inquiry allowed efficient development of role-specific service standards and quick evaluation of their implementation. This unique approach for improving healthcare service quality and identifying barriers to providing individual feedback may be useful to organizations navigating a more value- and consumer-driven healthcare market.

While previous research acknowledges the influence of roles on routine dynamics, roles are largely taken for granted. The purpose of this paper aims at examining how roles and routines interplay in accomplishing work in organizations.

A four-year ethnography of an emergency department (ED) at a university hospital was conducted through observations, interviews and documents.

Roles and routines are formed by scripted and unscripted patterns, which are brought into performances following a situational assessment. Performances trigger patterning processes prompting the co-construction of role and routine patterns.

This study highlights the importance of designing flexible structures. Managers can benefit from identifying unscripted patterns critical to work performance and making them part of scripted patterns. Managers should contemplate the influence that individuals, their relations and context have on how work is done.

This study suggests that the existence of different patterns impacts the length of wait times in EDs, a societal issue worldwide because of the effects that waiting can have on the patient's health condition and the unnecessary costs it carries. This study can help design solutions to decrease wait times.

This paper contributes to research on routine dynamics by providing a more nuanced explanation of the sources of endogenous change and how these enable organizational stability and flexibility.

There is a growing academic interest in the examination and exploration of work intensification in a wide range of healthcare settings. The purpose of this paper is to explore the differing staff perceptions in emergency ambulance services in the UK. It provides evidence on the challenges for the paramedic professionalisation agenda and managing operational demands and work intensity in emotionally challenging circumstances, with significant implications for patient safety.

Drawing on the evidence from an empirical study in a large National Health Service ambulance trust in England, this paper examines the challenges and differing staff perceptions of the changing scope and practice of ambulance personnel in the UK. Amidst the progress on the professionalisation of the paramedic agenda, individual trusts are facing challenges in form of staff attitudes towards meeting performance targets, coupled with rising demand, fear of loss of contracts and private competition.

Research findings highlight differing perceptions from various sub-cultural groups and lack of clarity over the core values which are reinforced by cultural and management differences. Need for greater management to explore the relationship between high sickness levels and implications for patient safety including the need for policy and research attention follows from this study. The implications of work intensity on gender equality within the ambulance settings are also discussed.

Ambulance services around the world are witnessing a strain on their operational budgets with increasing demand for their services. Study evidence support inconclusive evidence for patent safety despite the growing specialist paramedic roles. Organisational implications of high staff sickness rates have been largely overlooked in the management literature. This study makes an original contribution while building upon the earlier conceptions of work intensification.

The study findings have significant implications for the ambulance services for better understanding of the staff perceptions on work intensity and implications for patient safety, high sickness absence rates amidst increasing ambulance demand. Study findings will help prepare the organisational policies and design appropriate response.

Societal understanding about the organisational implications of the work intensity in an important emergency response service will encourage further debate and discussion.

This study makes an original contribution by providing insights into the intra-organisational dynamics in an unusual organisational setting of the emergency ambulance services. Study findings have implications for further research inquiry into staff illness, patient safety and gender issues in ambulance services. Evidence cited in the paper has further relevance to ambulance services globally.