One prerequisite for effective institutional care is that staff agree on how to deliver treatment and have a unified view of how to achieve changein other words, to have staff group unanimity (SGU). This study used the Correctional Program Assessment Inventory (CPAI) 2000, interviews with key staff, and observations of daily activities to examine the levels of SGU on eight treatment wards in Sweden. Results show that staff members had differing views of the theory and methods, low common therapeutic goals, low to modest confidence in management, and low agreement about how treatment should be delivered. At institutions displaying low and medium levels of SGU, observations revealed significantly less interactions between staff and residents, and the residents spend a lot less time in staff supervised activities than at institutions with a high level of SGU. This article also considers the complexity of promoting positive interactions among the staff while maintaining close relationships between the staff and residents. Abstract published by arrangement with Taylor and Francis.