A review of midwifery leadership
The ineffectiveness of leadership across maternity services in England has been a recurrent theme over a number of years, with reports continuing to identify the same issues. These reports reflect the concerns previously identified by the Healthcare Commission in its review of maternity services in England, which drew attention to the links between poor morale and ineffective or authoritarian leadership, as well as highlighting the overemphasis on financial pressures, all of which were concluded to be detrimental to the care provided for women. This article will explore the history of midwifery leadership, examining the reasons why midwives in particular have been perceived as failing to have developed the necessary skills to lead and manage maternity services.
Manchester coroner Lisa Hashmi identified ‘poor midwifery leadership and staffing levels as well as ambiguities in the Trust's guidelines’ (Gray, 2016) as key factors in the death of a newborn baby when reviewing the case. These concerns are reflective of the findings in numerous reports into maternity services in England (Healthcare Commission, 2008; Francis, 2013; Kirkup, 2015; National Maternity Review, 2016). In a review of maternity services, the Healthcare Commission (2008) specifically linked poor morale; ineffective, domineering leadership styles; and an overemphasis on financial pressures with poorer care for women. Midwife managers in particular have been perceived as lacking the necessary skills to lead and manage the maternity services, thereby impacting on the quality of care delivered (Smith and Dixon, 2008). While there has been progress in improving maternity outcomes, Amess and Tyndale-Biscoe (2014) have reported that outcomes and quality of care remain inconsistent for women across all Trusts in England, with an 80% rise in maternity claims over the last 5 years.
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