MIDIRS Essence > September 2010 > MIDIRS

Inside first: creating a value driven service

Originally posted on Sept 2010

by Debby Gould, Head of Midwifery, University College London

In these difficult times of recession, cut backs and uncertainty regarding the NHS, it is important to get midwives and nurses to understand their pivotal role in delivering high quality care.

Unfortunately it is also our clinical midwives and nurses who are most vulnerable to influence from other people and pressures which may lead them personally to cut corners in care in order to survive in difficult circumstances. The Mid Staffordshire Inquiry (The Mid Staffordshire NHS Foundation Trust Inquiry 2010) suggested that nurses may have become habituated into providing low standards of care. Therefore, little by little, they cut corners to get through their ‘work’ as they dealt with reducing staff levels, the more complex needs of the people they cared for and increasing targets to hit. This led to probable falsifying of records, higher morbidity and mortality rates and an increasing immunity to the need to protect the privacy and dignity of the people in their care. It is within the paradigm of treating people like ‘work’ and midwifery or nursing as a ‘job’ that caring and compassion is lost.

By getting midwives to re-engage in what made them become a midwife, I believe you can help overcome the conforming to institutional behaviours revealed in midwifery by Kirkham (2004) where midwives reported that they often knew that the care they were delivering was not evidenced-based or woman-centred but it let them live a more peaceful work life.

First it is important to realise that often midwives and nurses mean no deliberate harm. They are responding to their own subconscious minds (Murphy 2006). The subconscious mind always works to maximise personal survival as it sees it, whatever the circumstances. Staggeringly during our daily lives it is our vast subconscious mind, constituting 10/11ths of the brain, which drives most of our actions and behaviours, from respiration and walking to that instant reaction to a thought or comment. It is in a moment that ingrained attitudes and behaviours are triggered and exhibited. To address poor attitudes or behaviours or even passive complacency we need to break this cycle. We need midwives in their daily interactions to have different attitudes or behaviours triggered. We need to release attitudes and behaviours that drive midwives to advance advocacy and accountability with pride and determination, rather than retreat in passivity and be silently overwhelmed by the institutional norms. So how can we get midwives to re-engage with core values?

To enable this change to happen we must start on the inside. External compliance doctrines of accepted attitudes and behaviours are unlikely to have an impact on their own. We need to tap into personal motivation. It is vital to get midwives to re-enagage with their core values regarding caring for women. These core values often lie within and around the very reason they came into the midwifery profession. Often these are the very values that have been suppressed by other competing personal and emotional needs for survival; perhaps there is a fear of bullying, a needing to be liked and accepted, avoidance of criticism and failure and even for some avoidance of too much success.

Once midwives are re-engaged with their own core values, personal commitment to deliver high quality care will increasingly overcome institutional norms, especially if these values become embedded in the organisational culture so that their ‘work’ has ‘meaning’ and therefore is no longer just work. Core value engagement may also protect against distorted reward systems as their own subconscious mind will start to reject information which conflicts with their inner belief system.

Hence, obtaining group acceptance by putting institutional norms first will pale into insignificance when compared to deriving true meaning and satisfaction from being a true advocate for women. Frankel argues that ‘man’s search for meaning’ is the highest internal driver. We know from the Mid Staffordshire Inquiry and many disaster reports (Hadden-Cave 2009) before then, that high standards are not really driven by monitoring and checking processes but by professional integrity navigated by individual and shared core values. It seems crazy not to mobilise the highest internal driver present in all of us to deliver the highest standards of care to women and babies, and very foolish not to at least try to see if investment on exploring ‘inside first’ could have an impact.

To download and listen to Debby Gould's podcast 'Inside first: creating a value driven service' visit www.midirs.org/podcast.

References

• Frankl VE (2004). Man’s search for meaning: the classic tribute to hope from the Holocaust. London: Rider.
  
• Hadden-Cave C (2009). An independent review into the broader issues surrounding the loss of the RAF Nimrod MR2 Aircraft XV230 in Afghanistan in 2006. [The Nimrod Review]. London: The Stationery Office. Available from http://www.official-documents.gov.uk.
  
• Kirkham M ed (2004). Informed choice in maternity care. Basingstoke: Palgrave Macmillan.
  
• Murphy J (2006). The power of your subconscious mind. Rev. ed. London: Pocket Books.
  
• The Mid Staffordshire NHS Foundation Trust Inquiry (2010). Independent Inquiry into care provided by Mid Staffordshire NHS Foundation Trust January 2005 – March 2009. Volume I. Chaired by Robert Francis QC. London: The Stationery Office.

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