The principle of separate responsibility in clinical psychiatric practice. 6 years' experience.

Abstract

An experiment lasting 6 years with an organizational principle called 'separate responsibility' is described. Its aim was to promote open two-way communication in an acute psychiatric admission clinic, by dividing power, i.e. responsibility for individual patients and patients as a group, over two multidisciplinary treatment teams. Multidisciplinarity, however, turned out to be impossible to maintain for different reasons. Instead, a splitting occurred of medical and nursing disciplines through identification of the former with individual treatment and of the latter with the patient groups. An unproductive loss of common treatment goals was the result leading to a near closing down of the clinic. Putting medical and nursing personnel into one team, responsible for the entire treatment of the unit, restored productivity and improved treatment and the working climate.