Clinical leadership has a positive impact on quality of care, patient outcomes and experience (Jiang et al, 2009; Veronesi et al, 2013). It improves organisational performance, and it is associated with higher staff morale, retention and support for reforms (Sarto and Veronesi, 2016). To deliver safe, high quality maternity services, effective midwifery leadership is essential (National Maternity Review, 2016).
Evidence shows that experiential and work-based learning are among the most effective interventions for leadership development (Mianda and Voce, 2018). The new NHS Regional Clinical Fellow Scheme, which offers midwives the chance to take time out from their clinical role to work within health service leadership, is an avenue for this. It provides unique opportunities to learn leadership skills through enquiry and practice.
Midwifery leadership in the spotlight
In common with other national maternity reviews, the recent Ockenden review (2020) of maternity services at the Shrewsbury and Telford NHS Hospital Trust highlighted leadership issues as a key factor affecting care. Failures in challenging poor workplace culture and learning and quality improvement were seen.
Demonstrating their commitment to prioritising the leadership agenda, the Royal College of Midwives has launched their leadership manifesto (Royal College of Midwives, 2019). It recommends the strengthening of midwifery leadership structures, including directors of midwifery in trusts and health boards, and heads of midwifery within maternity units. The need to invest in leadership development and training for midwives is also emphasised. Some of the key leadership development challenges for midwifery include securing a diverse talent pipeline for senior leadership roles and ensuring development of early career professionals.
The extraordinary accomplishments of empowered clinicians during the COVID-19 pandemic have demonstrated the value of clinical leadership. Midwives at all levels have risen to the leadership challenge, from steering the rapid digitisation of maternity services to adapting care and stepping up support for women giving birth under the challenges of the pandemic. The NHS People Plan 2020/21 recognises the contribution of clinicians and commits to expand the opportunities and support to clinical leaders (NHS England and NHS Improvement, 2020).
Developing leadership through a clinical fellowship
Clinical fellow schemes have been shown to deliver substantial benefits for individuals and the organisations they work within (Grote et al, 2019; McKimm et al, 2019). Impact also extends wider, with programmes such as the Darzi fellowship raising engagement with leadership amongst clinicians and spawning leadership development throughout the wider health system (Stoll et al, 2011).
In April 2021, NHS England and NHS Improvement launched the NHS Regional Clinical Fellow Scheme. This multi-professional scheme gives early career midwives the opportunity to work for 12 months within an NHS England and NHS Improvement regional team on projects supporting recovery and implementation of learning from the pandemic, in order to develop leadership skills.
Participants of the scheme will have the opportunity to engage in varied programmes of work which may encompass service, policy or strategy development. Through these, they will gain experience of collaborative working, learning how to engage with stakeholders across organisational boundaries, communicate with varied audiences and influence. Fellows will develop the skills of systems leadership, understanding the key role of relationships and collective leadership.
With opportunities to lead on team-based improvement projects, fellows will be able to make a difference to patient care and gain key knowledge and skills in quality improvement, including how to deliver complex change and engage others in improvement. Alongside project work, fellows will also undertake a leadership development programme underpinned by supporting frameworks, thus allowing opportunities to link theory to practice, for the most effective leadership learning.
During the fellowship, midwives will be part of a community of early career clinicians from all professional groups, spanning doctors, nurses, pharmacists, dentists, AHPs and healthcare scientists. This offers great potential for interprofessional learning and working which will enhance leadership skills development (Reeves et al, 2017). Fellows will also develop in inclusive and compassionate leadership which is essential for our NHS leaders of the future.
Reflective practice is a key component of leadership learning and fellows will be supported in this through action learning sets, self-assessment tools and 360-degree feedback. This will help fellows to grow personally, to develop self-awareness, emotional intelligence and their own leadership style. Working closely with senior leaders, they will also benefit from role modelling and mentoring. On completion of the fellowship, participants will have access to ongoing development and support through the Alumni Scheme.
Get involved
The NHS Regional Clinical Fellow Scheme is looking for talented early career midwives who are motivated, adaptable and keen to develop their leadership skills to join the scheme. The fellowship is part-time (0.6 full-time equivalent) so participants will be able to maintain their clinical practice. The scheme is run by NHS England and NHS Improvement in partnership with the Faculty of Medical Leadership and Management, who have been running multiple successful clinical fellow schemes over the past 10 years.
Applications are welcomed from midwives working across all sectors and we are committed to recruiting diverse candidates. The first cycle will recruit fellows to start in post in September 2021. Further information and the online application portal can be found at www.fmlm.ac.uk/clinical-fellow-schemes/nhs-regional-clinical-fellow-scheme.
We welcome midwifery leaders across the NHS to engage with the scheme and encourage line managers to discuss leadership development opportunities with their staff. As well as personal and career development for fellows, the skills that fellows gain through the scheme, such as in quality improvement, can hugely benefit healthcare organisations (Royal College of Physicians, 2017).
For those interested in leadership development, the NHS Leadership Academy (www.leadershipacademy.nhs.uk) also offers a range of support, including leadership development programmes, e-learning, coaching, tools and resources for leaders at all levels.
References
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Royal College of Midwives. Strengthening midwifery leadership: a manifesto for better maternity care. 2019. www.rcm.org.uk/media/3527/strengthening-midwifery-leadership-a4-12pp_7-online-3.pdf (accessed 20 April 2021)
Royal College of Physicians. Evaluation of the RCP’s Chief Registrar programme. 2017. https://www.rcplondon.ac.uk/file/7772/download (accessed 20 April 2021)
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