Features

'As a leader you cannot be successful without good people around you'

When Gloria Rowland joined the maternity team at a Norfolk trust, morale was low, staff were not learning from clinical incidents, and the unit was losing money every year. She used her skills as a transformational leader to take the 'amazing' team with her on a journey that turned the struggling unit around.     
Gloria Rowland

When Gloria Rowland joined the maternity team at a Norfolk trust morale was low, staff were not learning from clinical incidents, and the unit was losing money every year. She used her skills as a transformational leader to take the 'amazing' team with her on a journey that turned the struggling unit around

I never wanted to be a head of midwifery I found myself in that position by default after I took a secondment role at a London trust that had previously been placed in special measures. I enjoyed the challenge and found my passion, myself even, as a transformational leader.

My first head of midwifery job at the trust was a great learning curve. Admittedly I made some mistakes, which was difficult for me because I am a perfectionist. My expectation then was that

...

When Gloria Rowland joined the maternity team at a Norfolk trust morale was low, staff were not learning from clinical incidents, and the unit was losing money every year. She used her skills as a transformational leader to take the 'amazing' team with her on a journey that turned the struggling unit around


Gloria Rowland knows the power of teamwork

I never wanted to be a head of midwifery – I found myself in that position by default after I took a secondment role at a London trust that had previously been placed in special measures. I enjoyed the challenge and found my passion, myself even, as a transformational leader.

My first head of midwifery job at the trust was a great learning curve. Admittedly I made some mistakes, which was difficult for me because I am a perfectionist. My expectation then was that every clinician had to be perfect, but the reality is that clinicians are humans and mistakes do happen.
 
I reflected on my leadership approach, learned a lot and adopted new techniques for managing people - helped by the mentoring I received from trust executives, coaches and externally from the Mary Seacole and Florence Nightingale scholar networks.

New post

I was determined to make the maternity unit work but I learned that as a leader you cannot be successful without good people around you. I was able to bring that insight to my appointment, in January 2015,  as head of midwifery at James Paget University Hospitals NHS Foundation Trust’s maternity unit, in Norfolk, whose subsequent transformation has been a team achievement.
 
Throughout my transformation programme at James Paget, I ensured that staff were involved and engaged with the process. I had to make them realise the situation we were in and share my vision for improvement. 
 
When I arrived I could see the scale of the trust’s problems; internal and external reports pointed to the need for a review of service delivery.
 
I realised that the immediate focus would have to be on strengthening weak governance arrangements, as well as tackling inter- and intra-professional relationships and cultural issues. Different professionals did not speak to each other. There was no structural process for patient complaints or feedback – nobody was learning from clinical incidents nor benefiting from service user involvement. Staff morale was low, leadership poor and the unit was losing money every year.
 
Following a short evaluation phase to confirm areas of concern, I developed a structured approach to implement improvements across all areas, with clear accountability and implementation milestones.
 
I used my experience of best practice elsewhere to identify and communicate the vision of where the unit needed to improve. Most importantly, I provided guidance on the tools and techniques required to achieve this vision.

Following standards

I decided to prioritise safety, then tackle the unit’s culture. It made sense to use the fundamental standards of the Care Quality Commission (CQC) for transformation work, known as SRECW: safe, responsive, effective, caring and well-led (see box below). These standards give direction on how to approach issues.

The SRECW approach

S Safe – governance and quality and safety
R Responsive – feedback/service development
E Effective – culture/efficiency/financial
C Caring – service user’s engagement and women’s experience
W Well-led – leadership/workforce/personal development planning

 

I looked at governance arrangements, reviewing structure and strategy. I established a weekly serious incident panel meeting and the investigation of near-misses, as well as setting goals for safeguarding investigations and closures.
 
I began to build user engagement so that feedback could improve our service. I rejuvenated the Maternity Services Liaison Committee – a service-user forum. I conducted a local service-user survey and used the feedback to improve services. A midwife was appointed to a women’s experience and debriefing role to seek feedback, resolve concerns at the lowest level and identify further areas for improvement.
 
To make the service more responsive, we set up a 24-hour triage system. This was led by a band 6 member of staff. I supported her but she did all the work, took the project on and ran with it. Now she has become a band 7.
 
Another example of our response to feedback was allowing partners to stay overnight during labour, birth and postnatal stays.

Praising staff

I began to analyse incidents and would pick a ‘message of the week’ for the staff. Compliments are important and I would write to members of staff when they did something right. I would use examples of good practice, gradually turning the blame culture into a learning culture.

And it was the culture that was the biggest struggle. I reviewed the relationships between the different groups of staff in midwifery, obstetrics and gynaecology. It was difficult at first because I was brought in from outside, but the executive team was supportive. Representation from all staff groups and the service users helped to develop the unit’s vision, and our teamworking improved drastically.
 
The biggest challenge was posed by the consultants: some of them believed that, because they were doctors, they held more power on the unit than midwives. However, they soon discovered that I know my stuff and am very visible on the floor. I find it easy to go from suit to scrubs and I gain respect from that. My clinical work gives me credibility and I am on the floor supporting staff during difficult periods.
 
Central to the consultants’ acceptance was involving them in everything I did. I sought their views first and asked to join their weekly consultant meeting, which they welcomed.
 
We established the Eden Team, which has clear accountability and responsibility for improving the experience of vulnerable women and their families. I also oversaw a refurbishment of the delivery suite, involving staff and service users in the process.

Improving efficiency

We were losing money on the maternity unit and I looked for ways to improve efficiency. The unit now contributes to the trust’s cost-effectiveness agenda by managing resources – staff pay and non-pay budgets – effectively and efficiently while providing quality care.
 
I undertook a review of the midwifery management structure, focusing on ensuring roles were clear. I then conducted a staff survey and devised an education, training and development plan. I also supported the review of the consultants’ job plans, and reviewed workforce planning, mandatory training and development, and staff establishment on the unit. The need to review staffing levels and the acuity of the women using our service was urgent – the previous in-depth review had been done in 2004.
 
The transformation had other challenges, such as the rapidly changing NHS, financial constraints and the introduction of revalidation. There were other national drivers including the Kirkup Report, Francis Report and the National Maternity Review.
 
And it was not just a case of developing the staff and the unit but learning to develop myself too. I learned that I needed to slow down to make sure I took people with me on the journey. And they accepted me as one of them, even though I was the only black midwife on the unit.
 
I expected to be there for 6 months but I stayed for more than a year. The unit scored ‘good’ overall in the CQC inspection I led before leaving the trust.
 
It would not be right to give myself all credit for the achievements – it really was a team effort. My management team (Jayne, Karen, Pip, Fiona and Daniela) was amazing. My job was to guide them through. I could see the midwives growing and now they are flourishing.

The vision for the maternity unit

The vision is to lead and develop excellent maternity and gynaecology services, by following principles of providing holistic nursing/midwifery/obstetric care to women, partners, babies and their families based on six domains of providing high quality care:

1) Patient safety and reliability of care
2) Patient experience
3) Efficiency of care via financial stewardship
4) Positive staff wellbeing/morale
5) Innovations and service improvements
6) Evaluation of care via audit and research.
Also providing an optimal gynaecology service by exploring new ways of working and embracing the ambulatory care model.

 


Gloria Rowland is associate director for midwifery and gynaecology nursing, West Hertfordshire Hospitals NHS Trust 

Want to read more?

Subscribe for unlimited access

Enjoy 1 month's access for £1 and get:

  • Full access to nursing standard.com and the Nursing Standard app
  • Monthly digital edition
  • RCNi Portfolio and interactive CPD quizzes
  • RCNi Learning with 200+ evidence-based modules
  • 10 articles a month from any other RCNi journal

This article is not available as part of an institutional subscription. Why is this?

Jobs