Expertise Leadership and Collaborative Working

Soo Downe, Sheena Byrom, Louise Simpson

• Publisher: Wiley-Blackwell
• Year: 2010
• ISBN:
  9781444329247
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing

Leadership, expertise, and collaborative working are fundamental aspects of efficient and effective healthcare. This book offers a comprehensive overview of the general theories, principles and points of good practice in each of these three areas. This general literature is then contextualised by theoretical and practical implications for maternity care, and illustrated with in-depth case studies of successful innovation and change in practice.

Essential reading for all midwives, midwifery students, and others working in or studying maternity care, this book helps readers understand the theoretical underpinnings of effective leadership, expertise and collaborative ways of working.

Special features:

• Part of the acclaimed Essential Midwifery Practice series
• A theoretical and practical exploration of the nature and application of leadership, expertise and collaborative working in midwifery
• Provides inspirational case studies of change and innovation
• Brings together national and international experts in the field

Part I

Leadership

Introduction to Part I

Sheena Byrom

The subject of leadership in general has received much attention throughout the world. Although there is a significant amount of research and expert opinion in relation to leadership and health professionals, there has been less examination of the issues relating to leadership and the midwifery profession.

Examination of the literature on leadership and that relating to midwifery reveals some evolutionary similarities. The dominant theories in both areas appear to be moving away from hierarchical models and towards those based on relationship. The emotional focus of midwifery work, and the philosophy of women-centred care where midwives support and nurture women, could be linked with transformational style leadership theory. While it has been suggested that there is a lack of effective midwifery leadership across the world, there are examples of midwifery leaders who are challenging that belief, through their dynamic leadership styles, in strategic development, midwifery research, education, academia and service provision.

In Chapter I, Sheena Byrom and Lesley Kay examine the general and specific literature relating to leadership theory. They provide a brief overview of various leadership styles and traits. The subject of whether leaders are born or made is debated, in addition to various approaches to leadership development. There is an agreement within the literature that leadership is an essential element of organisational success, and for maternity services leadership has been identified as a critical factor when considering optimum safety for mothers and babies. The chapter suggests that all midwives have a responsibility to ‘lead’ in certain circumstances – for example, they ‘lead’ women during the childbirth continuum in their daily work, they lead parent education sessions, and they facilitate birth. The chapter proposes that the way midwives ‘lead’ women or other midwives needs to be considered at all times if quality of care is to be improved.

Sheena Byrom, Soo Downe and Anna Byrom take a more theoretical approach in Chapter 2, in which they describe a ‘nested narrative review’ of the literature pertaining to midwifery, woman-centred care and transformational leadership theory. Midwives and midwifery have always championed a holistic approach to childbirth. Even though transformational leadership has been closely linked to feminine traits by some authors, there appears to be little in the literature about the possibility of adopting transformational leadership approaches in midwifery. The chapter reviews the literature of woman-centred care and transformational leadership separately. On the back of the findings, it is suggested that the two approaches have much in common. The authors suggest that adoption of transformational leadership styles may be welcomed, at least in some midwifery settings.

A series of case studies and personal reflections are set out in Chapter 3. Contributions include personal reflections from midwifery leaders working at various levels. Sue Henry, Sheena Byrom and Cathy Warwick offer insights from the UK as midwives working at local level, as a consultant midwife and as a national leader, respectively. Ngai Fen Cheung gives an example of leading radical change in China, and a service user leader, Mary Newburn, describes how she came to a position of national influence in maternity care. Individuals frequently describe being inspired by leaders. The chapter provides personal insights into how such people achieve their vision and their ultimate success. Their skill and capacity to develop others to succeed and their influence on maternity service development offer encouragement and inspiration to all midwives, now and in the future.

Chapter 4, written by Mary Renfrew, uses the subject of breastfeeding as a case study to examine ways of creating change at a wide range of levels, from the very local to the international. Mary describes ways in which her work has attempted to address challenges faced in terms of research, practice, policy, education and strategy. Crucially, she draws out lessons for leadership in creating change at scale. The chapter highlights the fact that success depends on all members of the team, each bringing their contribution, skills, expertise and talents. Mary is clear that successful leadership includes having the confidence to ask others to follow, and the ability to work in collaboration and to follow others in turn.

All the chapters in this section illustrate the need for courage, vision and conviction if leaders are to be effective. They set out the theoretical basis for leadership and provide examples of where good leadership has led to important changes at all levels. As such, they provide a set of principles and a series of templates for midwifery leaders in the future.

Chapter 1

Midwifery Leadership: Theory, Practice and Potential

Sheena Byrom and Lesley Kay

Introduction

In 2008 the World Health Organization (WHO 2008) highlighted consistent leadership as a vital element to improve maternal, newborn and child health, and as a crucial component for progress towards Millennium Development Goals 4 and 5. Whilst this is a global strategy, many countries are also individually promoting positive leadership as key to promoting safe and appropriate maternity care.

This chapter will provide an overview of theory underpinning the concept of leadership, with a particular focus on maternity services and midwifery care. It provides the reader with a basic insight into the current position of leadership within maternity services, and into the potential for improvement and aspirations for the future. Whilst reference is made to other countries, the majority of the examples of current practice apply to the UK.

Leadership and Leaders: Theory, Styles and Traits

Leadership theory has been debated for centuries throughout the world, and yet it remains difficult to give a precise and agreed definition to the word 'leadership' (Mullins 2009). Put simply, it could be described as a relationship through which one person influences the behaviour or actions of other people in the accomplishment of a common task (Mullins 2009).

The concept of leadership is related to motivation, communication and interpersonal skills (Tack 1984) and has been suggested as the critical variable in defining the success or failure of an organisation (Schein 2004). Successful leaders have emerged within community groups, religious circles, political arenas and armed forces, and their talents have ranged from leading a few individuals to leading whole countries.

It could be useful to consider the following suggestions from Anderson et al. (2009) when trying to navigate the leadership phenomenon.

• Leadership (and management) is about dealing with the boundary between order and chaos – management leans more towards the order side and leadership more towards the chaos/complexity side. The issue is to balance the maintenance of what is useful (unless it is dysfunctional) while developing the new, and managing the transitions from one state to another.
• Leadership has become much more prevalent as a word and concept and has taken over from management, important in the era of manufacturing.
• Good management is added to, not replaced, by leadership. Well-led change needs good management to implement and maintain it.
• Leadership as an activity has in recent years been seen to be more distributed. Although it is still seen as the responsibility of a significant few, it is also a concern of the many who can have significant impact. Leadership is in part about human capital, contained in individuals, but also partly about social capital, embedded in collectives and their relationships: teams, networks, whole organisations and even sectors and regions. This presents real challenges for leadership development.

Leadership is an integral part of the social structure and culture of an organisation (Mullins 2009). When contemplating organisational culture, consideration should be given to how leaders create culture, and how culture defines and creates leaders (Schein 2004). Interestingly, and relevant to this chapter, the Care Quality Commission (2008), in its survey of all UK maternity services, reported that poor morale and ineffective or authoritarian leadership are commonly linked. The Commission noted that this is likely to contribute to a less effective service. It recommended that hospital organisations (trusts) need to consider the culture within their maternity services.

The so-called ‘Great Man’ and ‘Trait’ theories were the basis for most leadership research until the mid-1940s (Bednash 2003) These theories suggest that leaders are born and not made, and that leaders possess certain innate qualities or characteristics such as interpersonal skills, judgement and fluency (Bass 1990). Contemporary opponents of these theories (Cook 2001; Gould et al. 2001) argue that leadership skills can be developed and are not necessarily inborn. Handy (1993) describes a major flaw of the trait theories: they disregard the influence of others or the situation on the leadership role. Trent (2003) agrees, maintaining that leadership requires collaborators more than charisma.

Vroom & Yetton (1973) and later Vroom & Jago (1988) developed a model called situational contingency theory. This theory considers how and the degree to which the leader engages his or her team members in the decision-making process (Vroom & Jago 2007). It suggests that the same leader can use different group decision-making approaches depending on the characteristics of each situation. ‘Style’ theory succeeded both trait and situational theories and concentrates on what effective leaders actually do as opposed to what sort of person they are. Leadership in this context is understood as a set of behaviours rather than a set of traits.

Lewin et al. (1990) undertook seminal work on leadership styles. They considered some leaders' need to demonstrate a degree of dictatorial authority as opposed to the readiness of other leaders to assume a more democratic role. Leaders taking an autocratic stance make decisions without consulting others. Ralston (2005) describes this type of style as ‘authoritarian’. Communication is top-down and staff are not expected or encouraged to take the initiative. In contrast, in the democratic style, the leader involves others in decision making and is often described as ‘participative’. This is usually appreciated by people and improves staff morale and ownership; however, problems can arise when there is a wide range of opinions and there is no clear way of reaching an equitable decision. In another approach, the laissez-faire style of leadership minimises the leader's involvement in decision making. Those of this ilk tend to lead by virtue of their position in the organisation, without necessarily displaying leadership skills (Ralston 2005).

Burns (1978) conceptualised leadership in terms of a leadership–member exchange model, a two-directional process between follower and leader. This differentiates between transactional and transformational leadership styles. Transactional leadership occurs when one person takes the initiative in making contact with others for the purpose of making an exchange (Conger & Kanungo 1994), whereas transformational leaders communicate positive self-esteem and empowerment of followers (Davidhizar 1993).

Transformational Leadership

The leadership style that is increasingly advocated in the healthcare literature is that based on the transf...

Table of contents

• Cover
• Title Page
• Copyright
• Dedication
• Contributors
• Foreword
• Introduction
• Part I: Leadership: Introduction to Part I
• Part II: Expertise: Introduction to Part II
• Part III: Collaboration: Introduction to Part III
• Index