What a great opportunity: 800 words to revolutionise midwifery! Perhaps my naïve ambition is somewhat overstated, yet change is necessary to prevent our nation's incredibly passionate tribe of midwives becoming discouraged by failings of ‘the system’. So what can we do?
Gordon MacKenzie (1998:30) described the corporate world as: ‘a tangled, impenetrable mass of rules, traditions, and systems, all based on what worked in the past […] that exercises an inexorable pull into mediocrity.’ I see parallels between this and the NHS but, as MacKenzie goes on to describe, we can learn to engage with established norms and still bring a sense of enthusiasm and motivation to inspire change. In my final year of study, I've been wondering how to ensure my own longevity in such a demanding career, and I wanted to share some of my attempts to make a difference and to develop when the expectation is to conform.
Midwifery receives the most positive user experience reports but has possibly the lowest staff morale (Royal College of Midwives (RCM), 2017; Care Quality Commission, 2018). Research has long recognised that optimism and happiness can result in increased work outcomes, productivity and problem-solving ability (Luthans et al, 2008), and who doesn't need that in midwifery? I have begun to seek joy and recognise achievements, weaving happiness into every shift. This can be as simple as placing a well-timed cup of tea in front of a colleague, retrieving equipment that has found its way into the wrong place, or celebrating another's success. I try to remember the names of everyone on my placements and, as a result, a somewhat unlikely friendship was born between myself and one member of domestic staff. She is a ray of sunshine every shift, offering me secret chocolates and an encouraging smile when we pass in the corridor.
Another method I use is Gawande's (2011) checklist manifesto, which describes how very simple checklists can improve safety. I started creating my own mental checklists to help remember clinical skills, but have now extended this to helping enrich families' experience of care, especially in worrying or distressing situations. My checklist for improving birth experience includes questions such as: is someone explaining what is happening? Am I leaving time for parents to voice fears or questions or am I filling the awkward silence? Are parents in control or am I imposing what I think is best? This technique improves the care I give and dispels feelings of guilt when things don't go to plan. I can leave a difficult situation knowing I helped empower those involved.
The NHS is all about teamwork and, in particular, learning to cultivate a team that is supportive and efficient, in spite of what can sometimes feel like an endless rotation of new staff and students. I wonder how many of us truly feel comfortable in our teams? Are we willing and equipped to build a team that welcomes feedback and praises innovation and leadership? Dysfunctions in a team are usually based on a lack of trust (Lencioni, 2002), and it takes courage to step out of your comfort zone, admit mistakes, or question or praise someone you are in awe of, or intimidated by. Syed (2016) recognised that health professionals were surrounded by a fear of failure, even though, in everyday life, mistakes are a crucial element of success. Allowing honesty and vulnerability builds trust and stronger teams, so I am going to find ways to praise my colleagues in the moment, to approach difficult conversations with confidence, and to allow myself to get it wrong.
Sometimes I feel an urge to rebel against ‘the norm’, which Gino (2016) suggests promotes innovation, improves performance and enhances a person's influence. The RCM (2017) reported that over half of midwives avoided toilet breaks. So go on, rebel. Take a loo break! Find a solution for that problem everyone complains about; you are the most qualified.
Attention to detail enables success, and when we feed into a system that works, it will support us. Perhaps midwifery doesn't need a revolution but an effective evolution to survive and flourish in the future: either way, the change begins with us.