Ayrshire Maternity Unit

Addressing Cultures and Behaviours in Ayrshire Maternity Unit

Background

Numerous complaints were received in relation to team behaviours within the ward areas which formed the decision to carry out a survey of staff within Maternity & Neonatal services to scope current culture therefore a range of questions were asked to ascertain how satisfied staff were at work and what we could do to support if not.

All nursing and midwifery staff within the Maternity and Neonatal departments from Band 2 to Band 8 were invited to participate in the survey.  All teams by band were invited to undertake a 360 Turas feedback exercise in order to self-reflect on their strengths and role within the current culture.  There are separate surveys for other specialities within Women and Children’s services such as Gynaecology, Sexual Health and Paediatrics that have been completed and require the same process of review and action planning.

Aims and Objectives:

• To establish the wellbeing and identify any culture issues within the Maternity and Neonatal settings within Ayrshire Maternity Unit.
• To undertake in the first instance, a staff survey asking key questions of all staff in these departments to establish learning opportunities and any good practice.
• To establish if there are any perceived issues with bullying, homophobia and racism, and act on these if applicable.
• To ensure senior management consider specific issues raised by staff where appropriate.
• The survey and reporting will be conducted maintaining confidentiality at all times.
• To ensure the final report is shared with all staff.
• Action plans to be formulated by individual departments and reported through the Women and Children’s Clinical Governance structure.

Assessment

What is the most positive thing about working in your department? 

Disappointingly, no one felt leadership was a positive experience within their department 

Below are some of the comments received;

• Very cliquey - depending on who's on the shift determines whether it's enjoyable or not, allocation is very unfair
• Line manager is unapproachable and always defensive. Staff are not all treated fairly or consistently. Staff are not encouraged or allowed an opinion if it differs from her own.
• Have worked in several hospitals and always enjoyed labour ward the most. Obviously the pandemic this year has changed the way in which we work and has increased the demands on us as healthcare professionals. Staffing has been diabolical some shifts, and it has been extremely frustrating and I genuinely feel that only by pure luck have we gotten through it without any serious incidents

Do you feel supported in your department?

Comments on why or what we could do to improve this included;

•  I feel it depends on who is coordinating. There are some band 7s who are more supportive and approachable than others. I think there needs to be a reminder to staff that asking for support is not a sign of weakness and shouldn't be made to feel this way. It is a sign of recognising your own limitations as part of our requirements as a professional.

• I feel as though sometimes that my manger shifts blame back onto us when things are not carried out or done correctly through lack of communication or guidance giving.

Staff were asked if they felt management in their department are approachable if they had any concerns.

• It was reassuring to see that most staff 75/82 (91%) feel the Band 7s are approachable or sometimes approachable when they have a concern. However work requires to be done to ensure Band 8a staff and the Head of Midwifery are approachable at all times. This requires further investigation. 

• We also asked if staff if they have approached a manager with a concern, were they satisfied with how this was addressed. It was encouraging to see that 52% advised they were satisfied or very satisfied, however 32% were not satisfied.  The remaining 17% did not have an opinion either way.

Have you ever witnessed or been subject to bullying in the workplace?

It was concerning to read that 24 members (29%) stated they had witnessed bullying and 18 (22%) stated that they had been subject to bullying.  Of these, the below examples were noted.

Have you ever been witness to or subject to homophobia in the workplace?

94% said there was no homophobia in the workplace, however, although the numbers were low, four people stated they had witnessed homophobia and a very low number of staff being subjected to this in the form of unacceptable language or being shown disrespect.

Have you ever witness or been subjected to racism in the workplace

Five people said they had witnessed racism and a very low number stated that they had been subject to racism in the workplace.  This was noted as in the form of general chat.

Recommendations

• SLWG (short life working group) to review report and form an action plan – this will have representatives from all departments.
• Professional development plans and Personal Development Reviews (Turas Appraisal) require to be addressed as priority.
• Raise awareness of a pathways for staff to raise any concerns.
• Arrangements to support staff to raise any bullying concerns to senior management should be put in place by the GM and team.
• The Give Respect Get Respect to be utilised along with formal awareness of staff support and other current policies.
• Psychological safety toolkit to be implemented and introduced within the department involving all staff.
• Team meetings to be reinstated for information sharing and inclusion of all staff. Consideration needs to be given to online platforms for meetings to allow accessibility.
• All staff should be encouraged to participate in the completion of staff surveys
• Formation of a structured debrief tool.
• Engagement with Clinical Supervision (Registered Staff).
• Utilisation of peer support in the Unit
• Development of consistent and supportive leadership within the departments

iMatter Outcome within Ayrshire Maternity Unit (AMU)

The AMU sub-report data shows that there were 383 recipients of the iMatter questionnaire and 177 responded giving an aggregated response rate of 46% and EEI score of 74.  In comparison, NHSAA Board overall response rate was 53% with EEI score of 77.

Where do we go from here?

Report to be distributed to all Nurse & Midwifery staff within Maternity and Neonatal services April 2022

• SLWG are invited to an away day in June 2022 with a view to drawing up action plans for each service
• These action plans will be developed and led by members of staff.  This will not be management led, but it will be supported by the management team.
• Repeat surveys will be undertaken to benchmark against the action plans
• Link iMatter feedback with repeat surveys feedback

Attica Wheeler

Head of Midwifery (Associate Director of Nursing Women and Childrens Services)

NHS Ayrshire and Arran,

Ayrshire Maternity Unit