Exploring work motivation in High and Intensive Care wards with the confession booth: An innovative approach

Background: In the Netherlands, the High and Intensive Care model has been developed to enhance the quality of care and reduce coercion on acute psychiatric wards, with staff recognized as a crucial factor in its successful implementation. However, high staff turnover threatens both sustainable implementation of the model and the well-being of patients and healthcare professionals. Objectives: To inform strategies for staff retention and recruitment, this study explores the motivations of professionals working on High and Intensive Care wards. Methods: We used an innovative arts-based method known as the 'confession booth' to collect data that uncovers deep motivations and encourages individuals to reflect anonymously. The confession booth, a designated room on the ward, invited staff to send voice messages via WhatsApp, in response to three prompts: 1) What impressed them most during their shift 2) What made them most proud, and 3) What frustrated them most. Settings: The confession booth operated simultaneously across eight High and Intensive Care wards in the Netherlands over the course of two weeks. Results: Thematic analysis identified four overarching themes, each comprising multiple subthemes: meaningful engagement, professional agency, collaborative competence, and security. Participants emphasized that High and Intensive Care work is driven by a deep sense of compassion and a strong commitment to supporting patient recovery. The complexity of the work, along with active involvement in clinical decision-making, was described as both meaningful and professionally rewarding. Effective teamwork, particularly within a flexible, skilled, familiar team, was seen as essential to both job satisfaction and safety. Feeling safe emerged as a crucial prerequisite for all aspects of the work in which effective collaboration and adequate support from law enforcement were essential to maintaining this safety. Conclusion: To safeguard care quality, the persistent vicious cycle of insufficient attention to staff retention must be broken through structural investment in well-being, recognition, and reward. Retention is shaped by meaningful work, opportunities to apply expertise, effective teamwork, and safe working conditions. The confession booth provided a flexible and anonymous space for reflection, offering valuable, though not unlimited, insights. These findings present a strong foundation for improving retention and recruitment within High and Intensive Care settings. Registration number: The Amsterdam Public Health Research institute embedded this study with reference number SQC20222-047 on August 2, 2022.