Staff Turnover in Assertive Community Treatment (Act) Teams: The Role of Team Climate

  • Xi Zhu
  • Douglas R. Wholey
  • Cindy Cain
  • Nabil Natafgi
Original Article


Staff turnover in Assertive Community Treatment (ACT) teams can result in interrupted services and diminished support for clients. This paper examines the effect of team climate, defined as team members’ shared perceptions of their work environment, on turnover and individual outcomes that mediate the climate-turnover relationship. We focus on two climate dimensions: safety and quality climate and constructive conflict climate. Using survey data collected from 26 ACT teams, our analyses highlight the importance of safety and quality climate in reducing turnover, and job satisfaction as the main mediator linking team climate to turnover. The findings offer practical implications for team management.


Assertive community treatment Staff turnover Team climate Job satisfaction Burnout 




This study was funded by the National Science Foundation (Grant Number SES 0719257).

Compliance with Ethical Standards

Conflict of interest

Xi Zhu and Douglas R. Wholey received the above-mentioned research grant from the National Science Foundation that supported the data collection for this study. The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study procedures were approved by the University of Minnesota’s Institutional Review Board. This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study. The paper has not been presented at a meeting, and is not under consideration in any other peer-reviewed journals for publication.


  1. Aarons, G. A. (2006). Transformational and transactional leadership: Association with attitudes toward evidence-based practice. Psychiatric Services, 57(8), 1162–1169. doi: 10.1176/ps.2006.57.8.1162.CrossRefPubMedPubMedCentralGoogle Scholar
  2. Aarons, G. A., & Sawitzky, A. C. (2006). Organizational climate partially mediates the effect of culture on work attitudes and staff turnover in mental health services. Administration and Policy in Mental Health and Mental Health Services Research, 33(3), 289–301. doi: 10.1007/s10488-006-0039-1.CrossRefPubMedPubMedCentralGoogle Scholar
  3. Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182. doi: 10.1037/0022-3514.51.6.1173.CrossRefPubMedGoogle Scholar
  4. Bond, G. R., Drake, R. E., Mueser, K. T., & Latimer, E. (2001). Assertive community treatment for people with severe mental illness: Critical ingredients and impact on patients. Disease Management & Health Outcomes, 9(3), 141–159. doi: 10.2165/00115677-200109030-00003.CrossRefGoogle Scholar
  5. Boyer, S. L., & Bond, G. R. (1999). Does assertive community treatment reduce burnout? A comparison with traditional case management. Mental Health Services Research, 1(1), 31–45. doi: 10.1023/A:1021931201738.CrossRefGoogle Scholar
  6. Carr, J. Z., Schmidt, A. M., Ford, J. K., & DeShon, R. P. (2003). Climate perceptions matter: A meta-analytic path analysis relating molar climate, cognitive and affective states, and individual level work outcomes. Journal of Applied Psychology, 88(4), 605. doi: 10.1037/0021-9010.88.4.605.CrossRefPubMedGoogle Scholar
  7. Colquitt, J. A., Noe, R. A., & Jackson, C. L. (2002). Justice in teams: Antecedents and consequences of procedural justice climate. Personnel Psychology, 55(1), 83–109. doi: 10.1111/j.1744-6570.2002.tb00104.x.CrossRefGoogle Scholar
  8. De Dreu, C. K. W., van Dierendonck, D., & Dijkstra, M. T. M. (2004). Conflict at work and individual well-being. International Journal of Conflict Management, 15(1), 6–26. doi: 10.1108/eb022905.CrossRefGoogle Scholar
  9. De Dreu, C. K. W., & Weingart, L. R. (2003). Task versus relationship conflict, team performance, and team member satisfaction: A meta-analysis. Journal of Applied Psychology, 88(4), 741–749. doi: 10.1037/0021-9010.88.4.741.CrossRefPubMedGoogle Scholar
  10. de Wit, F. R. C., Greer, L. L., & Jehn, K. A. (2012). The paradox of intragroup conflict: A meta-analysis. Journal of Applied Psychology, 97(2), 360–390. doi: 10.1037/a0024844.CrossRefPubMedGoogle Scholar
  11. DeShon, R. P., Kozlowski, S. W. J., Schmidt, A. M., Milner, K. R., & Wiechmann, D. (2004). A multiple-goal, multilevel model of feedback effects on the regulation of individual and team performance. Journal of Applied Psychology, 89(6), 1035–1056. doi: 10.1037/0021-9010.89.6.1035.CrossRefPubMedGoogle Scholar
  12. England, P. (2005). Emerging theories of care work. Annual Review of Sociology, 31(1), 381–399. doi: 10.1146/annurev.soc.31.041304.122317.CrossRefGoogle Scholar
  13. Estryn-Béhar, M., Heijden, B I J M Vd, Ogińska, H., Camerino, D., Nézet, O. L., Conway, P. M., et al. (2007). The impact of social work environment, teamwork characteristics, burnout, and personal factors upon intent to leave among European nurses. Medical Care, 45(10), 939–950. doi: 10.2307/40221534.CrossRefPubMedGoogle Scholar
  14. Gaba, D. M., Howard, S. K., & Jump, B. (1994). Production pressure in the work environment. California anesthesiologists’ attitudes and experiences. Anesthesiology, 81(2), 488–500. doi: 10.1097/00000542-199408000-00028.CrossRefPubMedGoogle Scholar
  15. Giebels, E., & Janssen, O. (2005). Conflict stress and reduced well-being at work: The buffering effect of third-party help. European Journal of Work and Organizational Psychology, 14(2), 137–155. doi: 10.1080/13594320444000236.CrossRefGoogle Scholar
  16. Glisson, C., Schoenwald, S., Kelleher, K., Landsverk, J., Hoagwood, K., Mayberg, S., & Green, P. (2008). Therapist turnover and new program sustainability in Mental Health Clinics as a function of organizational culture, climate, and service structure. Administration and Policy in Mental Health and Mental Health Services Research, 35(1–2), 124–133. doi: 10.1007/s10488-007-0152-9.CrossRefPubMedGoogle Scholar
  17. González-Romá, V., Peiró, J. M., & Tordera, N. (2002). An examination of the antecedents and moderator influences of climate strength. Journal of Applied Psychology, 87(3), 465–473. doi: 10.1037/0021-9010.87.3.465.CrossRefPubMedGoogle Scholar
  18. Griffeth, R. W., Steel, R. P., Allen, D. G., & Bryan, N. (2005). The development of a multidimensional measure of job market cognitions: The Employment Opportunity Index (EOI). Journal of Applied Psychology, 90(2), 335–349. doi: 10.1037/0021-9010.90.2.335.CrossRefPubMedGoogle Scholar
  19. Hackman, J. R., & Oldham, G. R. (1976). Motivation through the design of work: Test of a theory. Organizational Behavior and Human Performance, 16(2), 250–279. doi: 10.1016/0030-5073(76)90016-7.CrossRefGoogle Scholar
  20. Harrison, D. A., Newman, D. A., & Roth, P. L. (2006). How important are job attitudes? Meta-analytic comparisons of integrative behavioral outcomes and time sequences. Academy of Management Journal, 49(2), 305–325. doi: 10.5465/amj.2006.20786077.CrossRefGoogle Scholar
  21. Holtom, B. C., Mitchell, T. R., Lee, T. W., & Eberly, M. B. (2008). Turnover and retention research: A glance at the past, a closer review of the present, and a venture into the future. The Academy of Management Annals, 2(1), 231–274. doi: 10.1080/19416520802211552.CrossRefGoogle Scholar
  22. Hom, P. W., & Griffeth, R. W. (1995). Employee Turnover. Cincinnati: South-Western College Publishing.Google Scholar
  23. Hom, P. W., Roberson, L., & Ellis, A. D. (2008). Challenging conventional wisdom about who quits: Revelations from corporate America. Journal of Applied Psychology, 93(1), 1–34. doi: 10.1037/0021-9010.93.1.1.CrossRefPubMedGoogle Scholar
  24. Imai, K., Keele, L., Tingley, D., & Yamamoto, T. (2011). Unpacking the black box of causality: Learning about causal mechanisms from experimental and observational studies. American Political Science Review, 105(04), 765–789. doi: 10.1017/S0003055411000414.CrossRefGoogle Scholar
  25. Imai, K., Keele, L., & Yamamoto, T. (2010). Identification, inference and sensitivity analysis for causal mediation effects. Statistical Science, 25(1), 51–71. doi: 10.2307/41058997.CrossRefGoogle Scholar
  26. Jackson, S. E., Schwab, R. L., & Schuler, R. S. (1986). Toward an understanding of the burnout phenomenon. Journal of Applied Psychology, 71(4), 630–640. doi: 10.1037/0021-9010.71.4.630.CrossRefPubMedGoogle Scholar
  27. Janssen, P. P. M., De Jonge, J., & Bakker, A. B. (1999). Specific determinants of intrinsic work motivation, burnout and turnover intentions: A study among nurses. Journal of Advanced Nursing, 29(6), 1360–1369. doi: 10.1046/j.1365-2648.1999.01022.x.CrossRefPubMedGoogle Scholar
  28. Jayaratne, S., & Chess, W. A. (1984). Job satisfaction, burnout, and turnover: A national study. Social Work, 29(5), 448–453. doi: 10.1093/sw/29.5.448.PubMedGoogle Scholar
  29. Jehn, K. A. (1995). A multimethod examination of the benefits and detriments of intragroup conflict. Administrative Science Quarterly, 40(2), 256–282. doi: 10.2307/2393638.CrossRefGoogle Scholar
  30. Jehn, K. A., & Bendersky, C. (2003). Intragroup conflict in organizations: A contingency perspective on the conflict-outcome relationship. Research in Organizational Behavior, 25, 187–242. doi: 10.1016/S0191-3085(03)25005-X.CrossRefGoogle Scholar
  31. Lawler, E. J., Thye, Shane R., & Yoon, J. (2000). Emotion and group cohesion in productive exchange. American Journal of Sociology, 106(3), 616–657. doi: 10.1086/318965.CrossRefGoogle Scholar
  32. Lawler, E. J., & Yoon, J. (1996). Commitment in exchange relations: Test of a theory of relational cohesion. American Sociological Review, 61(1), 89–108. doi: 10.2307/2096408.CrossRefGoogle Scholar
  33. Lee, T. W., Mitchell, T. R., Holtom, B. C., McDaneil, L. S., & Hill, J. W. (1999). The unfolding model of voluntary turnover: A replication and extension. Academy of Management Journal, 42(4), 450–462. doi: 10.2307/257015.CrossRefGoogle Scholar
  34. Leiter, M. P., & Harvie, P. L. (1996). Burnout among mental health workers: A review and a research agenda. International Journal of Social Psychiatry, 42(2), 90–101. doi: 10.1177/002076409604200203.CrossRefPubMedGoogle Scholar
  35. Maertz, C. P., & Campion, M. A. (1998). 25 years of voluntary turnover research: A review and critique. International Review of Industrial and Organizational Psychology, 13, 49–81.Google Scholar
  36. Maertz, C. P., & Campion, M. A. (2004). Profiles in quitting: Integrating process and content turnover theory. Academy of Management Journal, 47(4), 566–582. doi: 10.2307/20159602.CrossRefGoogle Scholar
  37. Maertz, C. P., & Griffeth, R. W. (2004). Eight motivational forces and voluntary turnover: A theoretical synthesis with implications for research. Journal of Management, 30(5), 667–683. doi: 10.1016/ Scholar
  38. Maertz, C. P., Griffeth, R. W., Campbell, N. S., & Allen, D. G. (2007). The effects of perceived organizational support and perceived supervisor support on employee turnover. Journal of Organizational Behavior, 28(8), 1059–1075. doi: 10.1002/job.472.CrossRefGoogle Scholar
  39. Maslach, C., & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of Organizational Behavior, 2(2), 99–113. doi: 10.1002/job.4030020205.CrossRefGoogle Scholar
  40. Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001). Job burnout. Annual Review of Psychology, 52(1), 397–422. doi: 10.1146/annurev.psych.52.1.397.CrossRefPubMedGoogle Scholar
  41. Monroe-DeVita, M., Morse, G., & Bond, G. R. (2012). Program fidelity and beyond: Multiple strategies and criteria for ensuring quality of Assertive Community Treatment. Psychiatric Services, 63(8), 743–750. doi: 10.1176/ Scholar
  42. Monroe-DeVita, M., Teague, G. B., & Moser, L. L. (2011). The TMACT: A new tool for measuring fidelity to assertive community treatment. Journal of the American Psychiatric Nurses Association, 17(1), 17–29. doi: 10.1177/1078390310394658.CrossRefPubMedGoogle Scholar
  43. Morgeson, F. P., & DeRue, D. S. (2006). Event criticality, urgency, and duration: Understanding how events disrupt teams and influence team leader intervention. The Leadership Quarterly, 17(3), 271–287. doi: 10.1016/j.leaqua.2006.02.006.CrossRefGoogle Scholar
  44. Nahrgang, J. D., Morgeson, F. P., & Hofmann, D. A. (2011). Safety at work: A meta-analytic investigation of the link between job demands, job resources, burnout, engagement, and safety outcomes. Journal of Applied Psychology, 96(1), 71–94. doi: 10.1037/a0021484.CrossRefPubMedGoogle Scholar
  45. Phillips, S. D., Burns, B. J., Edgar, E. R., Mueser, K. T., Linkins, K. W., Rosenheck, R. A., & Herr, E. C. M. (2001). Moving assertive community treatment into standard practice. Psychiatric Services, 52(6), 771–779. doi: 10.1176/ Scholar
  46. Pines, A., & Maslach, C. (1978). Characteristics of staff burnout in mental health settings. Hospital & Community Psychiatry, 29(4), 233–237. doi: 10.1176/ps.29.4.233.Google Scholar
  47. Pritchard, R. D., & Karasick, B. W. (1973). The effects of organizational climate on managerial job performance and job satisfaction. Organizational Behavior and Human Performance, 9(1), 126–146. doi: 10.1016/0030-5073(73)90042-1.CrossRefGoogle Scholar
  48. Rabe-Hesketh, S., & Skrondal, A. (2012). Multilevel and longitudinal modeling using stata (3rd ed.). College Station: Stata Press.Google Scholar
  49. Rabe-Hesketh, S., Skrondal, A., & Pickles, A. (2005). Maximum likelihood estimation of limited and discrete dependent variable models with nested random effects. Journal of Econometrics, 128(2), 301–323. doi: 10.1016/j.jeconom.2004.08.017.CrossRefGoogle Scholar
  50. Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models: Applications and data analysis methods (2nd ed.). Thousand Oaks: Sage.Google Scholar
  51. Rollins, A. L., Salyers, M. P., Tsai, J., & Lydick, J. M. (2010). Staff turnover in statewide implementation of ACT: relationship with ACT fidelity and other team characteristics. Administration and Policy in Mental Health and Mental Health Services Research, 37(5), 417–426. doi: 10.1007/s10488-009-0257-4.CrossRefPubMedPubMedCentralGoogle Scholar
  52. Salyers, M. P., & Bond, G. R. (2001). An exploratory analysis of racial factors in Staff Burnout Among Assertive Community Treatment Workers. Community Mental Health Journal, 37(5), 393–404. doi: 10.1023/A:1017575912288.CrossRefPubMedGoogle Scholar
  53. Schneider, B., Ehrhart, M. G., & Macey, W. H. (2013). Organizational climate and culture. Annual Review of Psychology, 64(1), 361–388. doi: 10.1146/annurev-psych-113011-143809.CrossRefPubMedGoogle Scholar
  54. Shah, P. P., Dirks, K. T., & Chervany, N. (2006). The multiple pathways of high performing groups: The interaction of social networks and group processes. Journal of Organizational Behavior, 27(3), 299–317. doi: 10.1002/job.368.CrossRefGoogle Scholar
  55. Stein, L. I., & Santos, A. B. (1998). ACT: Assertive community treatment of persons with severe mental illness. New York: W.W. Norton & Company.Google Scholar
  56. Teague, G. B., Bond, G. R., & Drake, R. E. (1998). Program fidelity in assertive community treatment. American Journal of Orthopsychiatry, 68(2), 216–233. doi: 10.1037/h0080331.CrossRefPubMedGoogle Scholar
  57. Tett, R. P., & Meyer, J. P. (1993). Job satisfaction, organizational commitment, turnover intention, and turnover: Path analyses based on meta-analytic findings. Personnel Psychology, 46(2), 259–293. doi: 10.1111/j.1744-6570.1993.tb00874.x.CrossRefGoogle Scholar
  58. Tjosvold, D., Wedley, W. C., & Field, R. H. G. (1986). Constructive controversy, the Vroom-Yetton model, and managerial decision-making. Journal of Organizational Behavior, 7(2), 125–138. doi: 10.1002/job.4030070205.CrossRefGoogle Scholar
  59. Valentine, S., Godkin, L., Fleischman, G. M., & Kidwell, R. (2011). Corporate ethical values, group creativity, job satisfaction and turnover intention: The impact of work context on work response. Journal of Business Ethics, 98(3), 353–372. doi: 10.1007/s10551-010-0554-6.CrossRefGoogle Scholar
  60. Wholey, D. R., Zhu, X., Knoke, D., Shah, P., Zellmer-Bruhn, M., & Witheridge, T. F. (2012). The teamwork in assertive community treatment (TACT) scale: Development and validation. Psychiatric Services, 63(11), 1108–1117. doi: 10.1176/ Scholar
  61. Witheridge, T. F. (2010). Monitoring ACT fidelity on a routine basis: One state’s experience. St. Paul.Google Scholar
  62. Woltmann, M. S. W. E., Whitley, P. D. R., McHugo, P. D. G., Brunette, M. D. M., Torrey, M. D. W., Coots, M. S. L., & Drake, M. D. P. D. R. (2008). The role of staff turnover in the implementation of evidence-based practices in mental health care. Psychiatric Services, 59(7), 732–737. doi: 10.1176/ Scholar
  63. Wright, T. A., & Cropanzano, R. (1998). Emotional exhaustion as a predictor of job performance and voluntary turnover. Journal of Applied Psychology, 83(3), 486–493. doi: 10.1037/0021-9010.83.3.486.CrossRefPubMedGoogle Scholar
  64. Zohar, D. (2000). A group-level model of safety climate: Testing the effect of group climate on microaccidents in manufacturing jobs. Journal of Applied Psychology, 85(4), 587–596. doi: 10.1037/0021-9010.85.4.587.CrossRefPubMedGoogle Scholar
  65. Zohar, D. (2003). The influence of leadership and climate on occupational health and safety. In D. A. Hofmann & L. E. Tetrick (Eds.), Health and safety in organizations: A multilevel perspective (pp. 201–230). San Francisco: Jossey-Bass.Google Scholar
  66. Zohar, D., Livne, Y., Tenne-Gazit, O., Admi, H., & Donchin, Y. (2007). Healthcare climate: A framework for measuring and improving patient safety. Critical Care Medicine, 35(5), 1312–1317. doi: 10.1097/01.CCM.0000262404.10203.C9.CrossRefPubMedGoogle Scholar
  67. Zohar, D., & Luria, G. (2004). Climate as a social-cognitive construction of supervisory safety practices: Scripts as proxy of behavior patterns. Journal of Applied Psychology, 89(2), 322–333. doi: 10.1037/0021-9010.89.2.322.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Xi Zhu
    • 1
  • Douglas R. Wholey
    • 2
  • Cindy Cain
    • 3
  • Nabil Natafgi
    • 4
  1. 1.Department of Health Management and Policy, College of Public HealthUniversity of IowaIowa CityUSA
  2. 2.Division of Health Policy and Management, School of Public HealthUniversity of MinnesotaMinneapolisUSA
  3. 3.Department of Health Policy and Management, Fielding School of Public HealthUniversity of California Los AngelesLos AngelesUSA
  4. 4.Department of Health Management and Policy, College of Public HealthUniversity of IowaIowa CityUSA

Personalised recommendations