Leadership is a word readily banded around – when things go well, it is down to good leadership and when they don’t, who takes responsibility? Does it rest with the ‘senior’ midwife, the trust chief executive or the midwife delivering the care?
Key reports continue to highlight poor leadership as the reason that maternity services seem to be failing women and hampering continued development of the profession (CEMACE, 2011; NMC LSA reports, 2011-12; The King’s Fund, 2008).
Clinical leadership is a key part of a midwife’s role, yet if individuals believe that leading the profession is the remit of someone else, then it is understandable that midwifery leadership is open to criticism. Adding to a lack of awareness is the continued undervaluing and underfunding of education to remedy ineffectual leadership. So now is the time to understand what it looks like and how it should be addressed.
It is worth considering why midwives receive poor press in respect of leadership skills. It would make sense for such skills to be embedded in all aspects of a midwife’s role. The NMC Standards for Pre-Registration Midwifery Education (2009) does not include an essential skills cluster for the student midwife as a leader; in fact, leadership is not addressed as a requirement. There is reference to the need for a registrant to lead the care of women and discussions about such care, but while this is essential, it does not highlight the value of the midwife’s role in promoting the profession and for the continued development and improvement in care. It seems that in failing to adequately address clinical leadership at pre-registration level, the scene is set to assume the responsibility for leading lies elsewhere.
Introducing the principles supporting leadership skills throughout a student’s training, as well as continued development when qualified, is essential if midwives are to take hold of their profession. Not all will choose to follow a career trajectory towards a clear leadership position such as head of midwifery, however, every midwife needs to grasp the principles if they are to understand the development of their profession. For some midwives, a greater understanding of leadership may help them to develop their future leadership potential.
Midwives can also draw comfort from not being alone in the need for improving leadership skills. In 2006, work started on a framework for doctors, with the launch of the Medical Leadership Competency Framework in 2008. The approach was to underpin training with leadership principles and for these to be carried on throughout the medical career (NHS Institute for Innovation and Improvement, 2010).
In 2011, the National Leadership Council launched the Leadership Qualities Framework (LQF) (NHS Leadership, 2012) for all NHS practitioners. The LQF model at first sight appears complex (see diagram). There are seven domains, five of which are applicable to all clinicians, a further two – ‘creating the vision’ and ‘delivering the strategy’ – may be more applicable to senior leaders. However, in labelling domains to a specific role, there is a possibility that future leaders may feel excluded, and for some, a leadership role may feel alien, so it is essential to meet development needs appropriately. The Department of Health is committed to addressing leadership across all health professions and the new competency frameworks are part of this development.
April 2012 saw the launch of the NHS Leadership Academy, a body whose role is in part to support professional leadership.
There is an existing Midwifery Leadership Competency Model (RCM, 2006) developed for midwives reflects the overall approach identified in the seven domains of the LQF. Therefore, we need to explore the value of a new model applicable for midwives and consider if and how such a move will enhance the leadership skills of midwives.
The current midwifery leader’s model was last updated in 2006 and while the overall principles haven’t changed, some of the language used could benefit from a review. For example, the model talks about the midwife as ‘an advocate for women’. This is an important tenet to hold on to and midwives have an even greater role in empowering women, so perhaps this should move towards using terms like ‘working in partnership with women’.
The career-wide LQF model takes individuals from initial training to experienced practitioner and will enable those less experienced to identify and understand a progression route as a leader, and to consider their leadership role and expectations from the start of their career.
In November 2011, the RCM was invited by NHS Scotland to run a ‘leadership challenge’ – an all-day event in which teams of midwives worked together to solve strategic and clinical challenges. Each team was assessed against a generic, although modified, competency framework – a subset of the Clinical Leadership Competency Framework (NHS Leadership Academy, 2012). The day was a great opportunity to identify strengths and gaps in leadership skills so that a strategy can be implemented to support its development. These events are going to form part of the new RCM leadership menu.
Following on from this and after discussions with midwives and leaders, the RCM has decided to follow the LQF for future leadership programmes. This approach supports the ongoing discussions around embedding this model into pre-registration education, making leadership education seamless.
Currently the RCM is working to translate the LQF into midwifery language to enable midwives to see themselves along the leadership continuum. The first ‘official’ RCM leadership programme to use the LQF is the RCM development centre, which will run in May 2012. This two-day programme gives midwives an opportunity to explore their strengths and weaknesses and to consider how best to progress. As the existing leadership competencies reflected expectations of senior midwives, many less experienced midwives felt that the RCM programmes were not for them. The new LQF will enable practitioners to be assessed according to their individual experience and expertise.
For many years, leadership education has been underfunded. With many programmes costing upwards of £5000 for a week’s training, financial support and time are key, but many training budgets are unable to help midwives in their leadership development. However, the RCM is committed to addressing this and, as one of its member benefits, the cost of the development centre and the leadership programme is significantly reduced.
McBain et al (2012), in a study of non-NHS companies, identified that high-performing businesses make a 36% larger financial commitment to leadership education than poor-performing companies. While this study explores a business community, it may be possible to extrapolate some of the findings, particularly in recognising that leadership and management skills are not innate abilities in all, but skills that can be learnt and improved on with training and financial commitment.
Leadership will continue to underperform if there is a lack of investment into its development. As a consequence, the profession is unlikely to evolve.
A lack of leadership is not simply a problem for senior midwives and maternity managers, it reflects on the whole profession and the care of women, their babies and families.
RCM education and professional development advisor
Midwifery leadership programmes and events
► RCM Development Centre 10 to 11 July
► RCM Strategic Leadership Programme
25 to 27 September
► Discount available on all bookings before
4 June by quoting Midwives magazine
The King’s Fund. (2008) Safe births: everybody’s business. See: kingsfund.org.uk/publications/safe_births.html (accessed 15 May 2012).
McBain R, Ghobadian A, Switzer J, Wilton P, Woodman P, Pearson G. (2012) The business benefits of management and leadership development. See: managers.org.uk/research-analysis/research/current-research/business-benefits-management-and-leadership-development- (accessed 15 May 2012).
NHS Institute for Innovation. (2010) Medical leadership competency framework. See: institute.nhs.uk/assessment_tool/general/medical_leadership_competency_framework_-_homepage.html (accessed 15 May 2012).
National Leadership Council. (2012) NHS leadership academy. See: nhsleadership.org.uk/ (accessed 15 May 2012).
NHS Leadership Academy. (2012) Development of the leadership framework. See: leadershipacademy.nhs.uk/develop-your-leadership-skills/leadership-framework/the-framework-overview (accessed 27 April 2012).
NMC. (2009) Standards for pre-registration midwifery education. See: nmc-uk.org/Publications/Standards/ (accessed 15 May 2012).
NMC. (2012) NMC 2011-12 LSAA reports. See: nmc-uk.org/Nurses-and-midwives/Midwifery/NMC-Review-of-LSA-reports/NMC-Review-of-LSA-reports/ (accessed 15 May 2012).
RCM. (2006) Midwifery leadership competencies. See: rcm.org.uk/college/your-career/leadership/ (accessed 15 May 2012).