Competing Narratives, Competing Identities:
midwifery leadership from both sides of the chasm
Bernie Divall
phd10bd@mail.wbs.ac.uk
The Study
Midwifery leadership in the NHS has been highlighted for attention in recent years, with concerns over
the impact of poor leadership, and an ageing population of senior midwifery leaders (1). Leadership in
the NHS more generally has been criticised for its emphasis on hierarchical, top down development (2),
and for a lack of emphasis on the role of clinicians in effective leadership of the organisation (3). This
study looks at midwifery leadership development, one element being a focus on the narratives of current
leaders and the counter-narratives of clinical staff. That element is the focus of this poster presentation –
what emerges from the narratives of managers and clinicians, and what might be the impact of
opposing narratives?
Methods
In-depth, longitudinal, narrative interviews were conducted with 10 senior
midwifery leaders who had recently completed a leadership development
programme. Analysis elicited meta-narratives clustered around ‘the path to
leadership’, ‘I am still a midwife’, and ‘between a rock and a hard place’.
Questions were then posed via an online midwifery forum, based on the metanarratives of leaders, in order to elicit the views of clinical staff, and contrasting
meta-narratives were constructed.
Findings: three central narratives from both sides of the clinical-managerial divide
‘Wordles’ have been created to show the many topics covered in the narrative interviews
The Path to Leadership
‘I wanted to challenge the status quo. I
wanted to make a difference on a bigger
scale. Some elements of my journey may
have been unplanned, but I always knew I
needed that challenge.’
Counter-narrative:
‘Midwives become managers because they weren’t that good as
clinicians, or because they get fed up of frontline work. I wouldn’t want
to do their job.’
I am Still a Midwife
‘I’m still a midwife, even if I don’t work
clinically. Everything I do is driven by my
midwife identity. I’m still ‘doing’ midwifery,
just on a bigger scale, and I do understand
the problems that midwives face.’
Counter-narrative:
‘Managers cannot understand the day to day problems in midwifery if
they don’t work clinically. Non-clinical managers have no credibility.
They are ‘one of them’, not ‘one of us’.’
Future
leadership
Role identity
and credibility
A Rock and a Hard Place
‘It’s difficult, sitting between clinical
midwives and the Trust general managers. I
have sympathy for the midwives, and I
empathise with them, but I also understand
the relevance of management imperatives.’
Counter-narrative:
‘Managers are uncaring pen pushers, who have lost any sense of being
‘for’ midwives. They only care about saving money and making us
work even harder than we do already.’
Group
membership
Conclusions and Implications for Future Work
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Frontline midwives feared losing their midwife identity if they were to move into managerial positions in the NHS, and showed little understanding of the role played by midwifery managers.
Managers, on the other hand, continued to define their roles according to this midwife identity, although they appreciated the difficulties in maintaining credibility if they did not work clinically.
Leadership development at an early stage in midwives’ careers might give them a clearer understanding of the work involved in a managerial role, and increase its attractiveness as a career option.
Managerial midwives should be supported to continue with some clinical element to their role. This has the potential to narrow the chasm between managers and clinicians.
(1) Department of Health (2010) Midwifery 2020: delivering expectations.
(2) Department of Health (2008) NHS Next Stage Review.
(3) Department of Health (2009) Inspiring Leaders: leadership for quality