• Cultural review identifies “clique” of midwives whose behaviour went unchallenged by senior managers
  • Some staff have been unwilling to raise concerns and some claim managers don’t listen to them
  • Nursing director taking action to address concerns and improve communication and staffing

A “clique” of midwives at a teaching hospital’s maternity department has led to other staff feeling ostracised and unable to raise concerns, according to a leaked report.

A cultural review of maternity services at Wirral University Teaching Hospital Foundation Trust also found senior managers were aware of this clique and had “reinforced” its behaviour rather than challenge it.

The independently produced report said the group had become an “elephant in the room”, with senior managers aware of its impact, which included some staff feeling de-valued when raising concerns.

The review was conducted after concerns were raised in a Care Quality Commission report last year.

After enquiries by HSJ the trust agreed to share a full copy of the cultural review, and nursing director Gaynor Westray said the concerns were being addressed, including “appropriate management” action against individuals identified. She also stressed that the report had identified positives about the maternity department’s culture.

The review, which was carried out in January and February, interviewed 33 staff within the department, including healthcare assistants, doctors and midwives.

It said: “There appears to be a group of staff, described by many as a ‘clique’, particularly within the delivery suite, who are very close to one another. While creating a strong and supportive in-group, this has also resulted in the exclusion, and at times, ostricisation of others.

It added: “The influence of this group of staff also appears to have been reinforced at times by senior members of staff within the trust as the group, at times, develop a collective view upon which they campaign to have changes made. Whether this group have at times been right, or wrong, is not particularly of note, it is the climate, culture and tone that this creates for others in the working environment which needs to be acknowledged.”

It added: “While some [staff] highlighted an openness to raising questions and alternative views, this tended to be in the context of clinical decision making. There were some examples of when this had been done and more junior/inexperienced members had been made to feel de-valued.

“However, the willingness to raise behavioural observations or concerns is much less prevalent and welcomed. In the conversations there were examples of behaviour that people had been unwilling to challenge for fear of the reaction they may receive. In addition, it was clear that a number of people felt senior managers were aware of counter-productive behaviour but had chosen not to address this, and that knowledge of the group was somewhat of an ‘elephant in the room’.”

Robertson Cooper, a business psychology company, was asked to carry out the review after the CQC raised concerns about maternity services.

The trust’s Arrowe Park Hospital maternity unit handles over 3,300 births a year and employs 119 full time equivalent midwives.

The CQC identified a number of positives about the unit and said many staff had pride and satisfaction in their work.

But it also identified concerns about the workload for staff despite improved staffing levels and concerns that change was not managed well and relationships between staff and communication with senior managers could be improved.

It added: “A number of contributors also commented that they felt that managers do not listen to them. This particularly related to raising concerns or difficulties about changes or decisions that appear to have already been concluded.

“There were several instances of managers either choosing not to address, or feeling unable to address issues with particular members of staff.”

It also said root cause analysis was not managed well and some people “felt that the process created feelings of blame and criticism rather than being a more clinically neutral process of creating shared understanding and learning.”

Ms Westray told HSJ she was keen to tackle the concerns after being appointed in February this year.

She said: “There are a lot of positives in the report and the majority of the workforce said they had a purpose, they felt they had a reason to come into work and they liked working in our hospital and providing the care they do to mums and babies.”

But she accepted there were issues of concern adding: “I have done a lot since the report and [the clique] does relate to a very small number of people. Of those staff who have been identified appropriate management processes have been implemented by myself personally following the findings of the report.”

She said the report and actions that will be taken had been shared with the board. The trust has a new head of midwifery and matron and is introducing a new e-rostering system to ensure better workload and staffing skill-mix in maternity.