British Journal Of Midwifery - Engaged midwives offer better care

Abstract

Policy documents have made recommendations for improving our maternity services, but these can only be implemented with the support of an engaged workforce, says Jacqueline Dunkley-Bent.

Better Births, the report of the National Maternity Review (2016), set out its ambition and advanced recommendations that, if implemented, will transform maternity services in England. Similarly, the recently published review of maternity and neonatal services in Scotland (Scottish Government, 2017) has focused on the provision of: safe, high-quality, accessible care; the availability of choice; continuity of carer; personalised care; improved and seamless multi-professional working; and neonatal and perinatal mental health services.

Such policy drivers shine the spotlight on maternity services for the right reasons and have created an era of excitement and anticipation among maternity service users and most midwives. Successful implemen-tation relies, in part, on midwives being engaged, willing and able to be the change.

Are midwives engaged?

Engaged staff are individuals who are ‘committed to their organisations [and] involved in their roles… more likely to bring their heart and soul to work… and collaborate effectively’ (The King's Fund, 2015: 2).

A Royal College of Midwives (RCM, 2016) report presented findings of a survey with 2719 midwives who have left the profession in the last 2 years or are intending to leave in the next 2 years. The main reasons for midwives wanting to leave midwifery related to dissatisfaction with staffing levels (52%) and limited time to provide high-quality care (48%). Other reasons included not being happy with the workload (39%), support from managers (35%), working conditions (32%) and the model of care (30%).

While there are many initiatives aimed at addressing these challenges, midwives and the wider workforce must be engaged and prepared if implementation of maternity policy is to be successful and sustainable.

Better maternity care

Evidence shows that engaged staff provide better health care. Staff engagement is associated with low mortality rates and appropriate use of resources (West and Dawson, 2012). Engaged staff are likely to have the emotional capacity to express empathy and compassion, regardless of work stresses.

While developing engaged staff is a long process, board members, midwifery leaders, managers and other colleagues can start making a difference by following the ‘six building blocks for a highly engaged workforce’ (The King's Fund, 2015):

Develop a compelling, shared strategic direction. This is concerned with the development of a clear, authentic, meaningful vision that permeates all levels of the service and infiltrates the hearts and minds of all staff. The vision should be reflected in staff objectives and appraisals. Evidence shows that leaders who do this have engaged staff who are passionate about their work and perform well (MacLeod and Clarke, 2009)

Collective leadership. Supporting all staff to play a leadership role rather than adopting a top-down approach enables all staff to have the authority, obligation and means to improve care. This distribution of power helps to develop a workforce that is engaged

Supportive and inclusive leadership style. Again, this helps to develop an engaged workforce

Give staff the tools to lead service transformation: empower midwives to have authority and control over their work and environment. Giving them an opportunity to grow and develop supports them to become leaders of change

Establishing a culture based on integrity and trust takes time, but authentic leaders, who live and act the vision, create a culture where their staff are less likely to be distrustful and disconnected from the vision of the organisation

Placing staff engagement firmly on the board agenda should ensure that it remains a priority, rather than an activity that symbolises corporate ‘good will’ without meaningful change.

For transformation of maternity services to be successful and sustainable, there must be a readiness and willingness to engage with all midwives and other maternity staff. Leaders and managers who follow these building blocks for a highly engaged workforce will support the development of midwives who: lead their own space within a trusting environment; are committed to their organisation; are actively involved in responding to policy drivers; take the initiative; and go above and beyond the call of duty.