Armstrong (2012, pp. 24 & 30) defines management as:
. . . the process of ‘making things happen’, and ‘getting things done through exercising leadership’.
He sees management as ‘the act of getting people together to accomplish desired goals . . .
There is confusion within many institutions around the differences between a manager and a leader; this may be because these terms are often used interchangeably in many arenas. In
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practice, there is a manager for each area who ensures that the work is done and that policies and procedures are followed. They deal with operational issues such as staffing and the day-to-day running of the practice area. These managers may have leadership qualities, in that they can inspire staff, but this is not necessarily seen as essential for their role. Pinnock (2012) high-lights the role of managers in developing an effective environment for safe care. He identifies the importance of the managers in making the link between the Trusts and the staff. He argues that ward managers should be clearly identified as leaders.
There can be difficulties in relation to management of teams in that practitioners are often organised in multiple teams. Within these different teams there may be different managers for different team members. Bucknall and Forbes (2009) identify that this can lead to role boundary issues and conflict. Managers are often easily identified within a framework, but leaders are less clearly identified unless they have a specific title. Practitioners may choose who they see as a leader, and this may be someone they do not work with directly, but who they admire and aspire to be more like. These issues can be further complicated with the use of other terms, such as:
co-ordinators, team leaders, consultant midwives, Supervisor of Midwives and preceptors. The key issue is not to get bogged down in terminology, but to seek out and identify leaders (who may also be managers) to inspire and challenge us.
Activity 2.3
Think of a person who has inspired you. What was it about that person that made you feel the way you did? Would you call this person a leader? Have you recognised this in some of the women in your care?
The importance of having a good working environment is well documented with working in
‘a positive working environment’ identified as a right for staff (DH 2013a, p. 13). Each individual has their own idea of what this is, often based on experiences of positive and negative working environments. There is a general consensus that the environment within health services influ-ences the quality of care offered and the job satisfaction and motivation of staff (DH 2013a;
Glasper 2010; Hutchinson et al. 2010; NICE 2009). The report by the National Advisory Group on Safety of Patients in England (2013, p. 8) identifies:
. . . good people can fail to meet patient’s needs when their working conditions do not provide them with the conditions for success . . .
One of the recommendations of the report is that leaders take action when they identify poor team working, giving specific examples of the change in practices that are needed to build the leaders that are needed in today’s NHS.
Activity 2.4
Read: page 17 of the report: National Advisory Group on the Safety of Patients in England (2013) [available online] https://www.gov.uk/government/uploads/system/uploads/attachment_data/
file/226703/Berwick_Report.pdf
Reflect on how the changes could impact on you, midwives and women. Then read page 44, which is a letter to all staff that work in the NHS and think about what this message means to you.
27 Ortega et al. (2012) demonstrates how important a learning environment is to staff, where workers feel safe to reflect on and challenge the activities of the team.
Activity 2.5
What do you think makes a good working environment? Can you think of a time when you experienced such an environment and how this made you feel? Relate this to the women being cared for and how the environment can impact on them.
Activity 2.6
Read: Brown, J. Lewis, L. Ellis, K. Stewart, M. Freeman, T. Kasperski, M. (2011) Conflict on
interprofessional primary healthcare teams – can it be resolved? Journal of Interprofessional Care 25, pp. 4–10.
Think about what this says about how conflict occurs, prevention and resolution of conflict.
There are currently concerns around bullying cultures in the workplace (Barber 2012) and the impact that this can have on team working. This is not a phenomenon exclusive to the NHS and is often of multifactorial origin. Bullying has been defined as:
. . . repeated offensive behaviour through vindictive, cruel, malicious or humiliating attempts to undermine an individual or group of employees . . .
(Yildirim 2009, pp. 504–505) This practice is illegal and all employers should have anti-bullying policies (Advisory, Concilia-tion and ArbitraConcilia-tion Service (ACAS) 2013; DH 2013a) set up to protect practiConcilia-tioners and other workers. However, it can be difficult for people to speak up about such issues, particularly if the person is in a position of power. All practitioners need to examine their own behaviour and ensure that they are not using any ‘bullying’ tactics (Curtis et al. 2006; Keeling et al. 2006). They also need to articulate to others that this type of behaviour is unacceptable. Lewis (2006) describes how passive acceptance of verbal abuse by seniors to more junior members of staff, who tolerate this because they view it as ‘just part of the job’, normalises such behaviour, thus making it appear acceptable. The NHS Constitution (DH 2013a) is clear that bullying must not be tolerated.
There are strategies around conflict resolution, which can be used to mediate and address conflicts within teams (Lee et al. 2008; Trivedi et al. 2008). Brown et al. (2011) identified in their study the issue of conflict within teams. They looked at how conflict may have arisen and the factors involved in its resolution. They identified ‘humility’ as a key characteristic, which assists in preventing and resolving conflicts.
Manley and McCormack (2008) highlighted the importance of culture in ensuring care is compassionate and women-centred. This is also a key component of the education of health-care workers, which calls for the learning environment to emphasise the need for health-care and compassion in both practical and theoretical terms. This is identified by Perkins et al. (2012) as
‘human flourishing’. Everyone needs to take responsibility for the environment in which they work, whether this is in the clinical environment or in university. It is important to ensure that everyone within a team reflects on how their behaviour affects other team members, both in a positive or negative way, to identify areas for development.
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