Midwife conceptualizations of clinical leadership in the labor ward of district hospitals in KwaZulu-Natal, South Africa

Abstract

BackgroundIn South Africa, inadequately skilled health care providers and poor clinical leadership are continually linked to preventable perinatal and maternal mortality, which calls for improved clinical skills among health care providers and for strong clinical leadership at the bedside. Very little has been done to ensure clinical leadership at the bedside in the labor ward of district hospitals. One strategy implemented has been the appointment of District Clinical Specialist Teams, introduced to improve the quality of maternal and child health care in district hospitals and clinics through the provision of clinical leadership as an outreach activity. However, the strengthening of clinical leadership at the bedside remains neglected. Further, clinical leadership in the literature is not conceptualized in the same way across settings.AimTo explore midwife conceptualizations of clinical leadership in the labor ward of district hospitals in KwaZulu-Natal.MethodsIterative data collection and analysis, following the Corbin and Strauss grounded theory approach, was implemented. In-depth interviews were carried out with the midwifery members of the District Clinical Specialist Teams in KwaZulu-Natal. The emergent theoretical framing of clinical leadership was presented and discussed at a workshop with broader midwifery representation, leading to a final proposition of the conceptualization of clinical leadership among midwives.ResultsThe emergent conceptualization of clinical leadership comprised five major dimensions: the definition of clinical leadership, the context in which clinical leadership takes place, the conditions related to clinical leadership, the actions and interactions involved in clinical leadership, and the effects of clinical leadership.ConclusionClinical leadership is an emergent phenomenon arising from dynamic interactions in the labor ward and the broader health system, which converge to attain optimal patient care. Clinical leadership is not being understood from a traditional hierarchical perspective, as vested only in a positional leader.

Enablers and barriers to clinical leadership in the labour ward of district hospitals in KwaZulu-Natal, South Africa

“…26 49 50 Visibility is an important relational skill required to ensure optimal patient care. 26 51 52 The shortages of positional clinical leaders makes it difficult for the few available positional clinical leaders to be visible in labour wards and to provide effective clinical leadership. 25 In this study, it was reported that positional clinical leaders struggle to balance between clinical leadership and managerial roles, consistent with other studies.…”

“…50 An environment where all healthcare providers could effectively contribute to patient care was seen to be an essential factor influencing clinical leadership in labour wards. 26 Communication and teamwork facilitate cohesion, development of interpersonal skills of the care team and interprofessional collaboration through discussion and reflection on practice. 56 Midwives expressed that doctors did not value midwives' contribution to patient care, which is at odds with labour wards in district hospitals, where most deliveries are midwife-led.…”

“…24 Clinical leadership in the labour ward of district hospitals in KwaZulu-Natal (KZN), South Africa, has been conceptualised as an emergent phenomenon arising from dynamic interactions in the labour ward and the broader health system, which converge to attain optimal patient care. 26 However, the enablers and barriers to the realisation of this conceptualisation of clinical leadership are not well understood. Table 1 Measures for ensuring trustworthiness…”

Midwifery Leadership

“…Effective leaders need to develop capacities from all three areas. They must be good managers able to guide administrative processes in the ward, in the institution and nationally depending on where they work (USAID 2015 ; Divall 2015 ; Mianda and Voce 2018 ).…”

“…Mianda and Voce ( 2018 ), Jarvis and Reeves ( 2017 ) and Divall ( 2015 ) point out a gap that has persisted in midwifery leadership and clinical leadership. Emphasis has been placed on position leadership to the neglect of leadership on the bedside and in the maternity ward.…”