Professionalism and person-centredness: developing a practice-based approach to leadership within NHS maternity services in the UK

Abstract

AcknowledgementsThis work was supported by the Health Foundation, an independent charity working to improve the quality of health care in the UK under Grant 4421/4048. The authors are grateful to the participating midwives, obstetricians and childbearing women.The authors declare that there are no conflicts of interest regarding the publication of this paper. *corresponding author2 Abstract This paper, based on data taken from in-depth interviews with senior midwives and obstetricians and conducted as part of a critical ethnographic study, argues for a greater appreciation of person-centred, value-led midwifery practice. The paper begins with a discussion of the way midwifery practice is shaped by encoded and embodied knowledge. The paper subsequently focuses on an emergent practice based leadership using an adapted Aristotelian conceptual framework derived from MacIntyre (2007). Professional dissonance is highlighted as a difficulty experienced by repositioned managers who are also expected to be leaders in their field. Using data gathered from in-depth interviews it is contended that establishing person-centred care might be better achieved through the development of practice based leadership (rather than solely by adherence to organisational requirements). This type of leadership could potentially nurture a professional environment that promotes qualities, such as agency, commitment and high levels of competence among midwives. Such leadership is central to UK government priorities and is applicable to a global practice development agenda.

Joys and challenges of relationships in Scotland and New Zealand rural midwifery: A multicentre study

“…when a midwife is tired and needs to sleep and a colleague or family member makes a cup of tea the midwife will feel cared for and appreciated. Midwives have been found to feel less stressed the more control they have over their working conditions and when they work in supportive and collegial workplaces 8,33,34 .…”

“…Also, health and social care contexts, nationally and internationally, where organisational and hierarchical forms of managerialism exist (e.g. in the NHS in the UK) may be detrimental to enhancing social capital, 33 lessoning social trust and collective solidarity.…”

Community mental health nurses' and compassion: an interpretative approach

“…Research and literature in other healthcare professions (Bolton , Hunter & Deery , Deery & Fisher , Walsh , Dewar & Christley ) have indicated that compassionate care is far less likely to emerge in contexts characterized by increasing organizational demands and where staff have no time to reflect on practice. The Francis Report (Francis ) highlighted an NHS organizational culture that is often based on a ‘solipsistic view of human nature that is neglectful of relationships’ (Fisher & Freshwater , p. 1) and a task‐based culture that prioritizes meeting targets over the provision of models of practice that are centred around relationships (Deery & Fisher ). Participants in this study recognized compassionate practice as an emotional response and a driving force underpinning the provision of relationship‐based care but at the same time identified difficulties engaging with compassionate practice.…”

“…The Francis Report (Francis 2013) highlighted an NHS organizational culture that is often based on a 'solipsistic view of human nature that is neglectful of relationships' (Fisher & Freshwater 2014, p. 1) and a task-based culture that prioritizes meeting targets over the provision of models of practice that are centred around relationships (Deery & Fisher 2016). Participants in this study recognized compassionate practice as an emotional response and a driving force underpinning the provision of relationship-based care but at the same time identified difficulties engaging with compassionate practice.…”

Followership: much more than simply following the leader

“…[23] Distributed, dispersed leadership [24] A collaborative (collective) follower sees the advantages of working closely with others. Willing to help develop a culture that shares and distributes power throughout the organisation Offers to take leadership even if low in the hierarchy A leader who works in a collaborative way in multidisciplinary teams and projects Involves and empowers them in initiatives and projects as an equal Asks them to take on leadership roles within their scope of competence Relational, transformational leadership [25][26] A transformational follower is heavily invested in people, relationship-building and helping others achieve their own potential A leader who pays attention to them, their career development and personal growth, who gets to know them as a person, who stretches them, provides effective feedback and communicates regularly and appropriately Complex adaptive leadership [27][28][29] A complex adaptive follower is willing to work with ambiguity and 'mess', has 'cognitive complexity', seeing the system as a complex, interconnected whole and promotes interdependent working A leader who operates at system level, understands the interdependency of teams, departments, services and organisations Involves them in service change and new pathways Inclusive, person centred [30][31] An inclusive, person-centred follower welcomes and values true diversity (of ideas, views, personal characteristics), Focussed on involving people in decisions, co-creating ideas and initiatives A leader who clearly values people, includes everyone in conversations and developments Doesn't pay lip service to listening to ideas that are different from their own Servant leadership [32] A servant follower is one who works with humility, integrity, wisdom and altruism for the greater good, wants to make a difference (to lives, to services) and leave a lasting positive legacy A leader who is humble and who can articulate their core values around why they became (and still are) a doctor or health professional Willing to go the extra mile for their patients/service and values followers who do so Value led, ethical, moral leadership [33][34][35] A value-led, ethical follower is highly driven by their core values and sense of purpose, wants to do 'the right thing'. May be an activist or whistleblower in driving change and tackling injustice A leader who holds and demonstrates core values, an ethical stance and attention to rules Supports their followers in challenging injustice or poor care Willing to speak out Finally, when working in the 'leadership triad', it is not always about the 'what' to do or the 'how' to do it that it important, it is the 'why' that we need to be clear about, and once we have identified the core purpose of why people come into healthcare and leadership, the rest will follow.…”