The B Word

Sadly and shamefully, allegations of bullying rumble intermittently throughout Grumpy Midwife’s workplace like distant thunder on an otherwise pleasant summer’s day. The fact that her particular corner of the maternity services is not unique in this experience and that bullying permeates the NHS (see, for example, NHS Staff Surveys and the Francis Report) is no comfort nor justification; GM is just terminally fed-up with comforting tearful juniors belittled in front of patients, care assistants alternately excluded and unappreciated, and doctors feeling bamboozled by bossy midwives.
A busy labour ward is possibly one of the most challenging places to work within the NHS: pace of work and interface with the public akin to A&E on a Saturday night, skills and technology to match that of HDU, inter-agency working reflective of an inner-city health centre, personalities that make the Bolshoi Ballet look boring. And senior labour ward midwives are necessarily a tough breed, juggling the demands of the services (limited beds, limited staff, limited time) with the needs of patents promised “choice” throughout childbirth. Back in the day, Grumpy Midwife tried to be tough, but wasn’t very good at it.
On the other hand, labour wards are also surely the happiest of places to work! Midwives are well-trained and motivated – and queuing up for jobs. Management is tight and professional supervision excellent. So what is the problem?
One of the most exciting, most innovative, most sensible papers on leadership Grumpy Midwife has read recently (and, believe me, she’s read a lot) is Followership in the NHS by Keith Grint and Clare Holt (available on The King’s Fund website). To cut 22 pages short, there are three types of problems: tame, wicked, and critical.
Tame problems have arisen before and are likely to do so again. They require a management solution; implementation of standard procedures and routine actions (although this is not to diminish the skill required); covering for unexpected staff sickness, for example, or getting the labour rooms cleaned quickly for women waiting for admission.
Wicked problems are more complex; they are deeply rooted in context, and there is no clear relationship between cause and effect. Wicked problems are often intractable; drug errors in spite of endless training, poor team working in spite of communications sessions, unhappiness at work in spite of (let’s be honest) fairly good pay. 
Critical problems are self-evident; fire, haemorrhage, collapse of mother or baby. Midwives are good at critical problems; the emergency bell goes and everybody runs and generally mills around shouting until the crisis is resolved. Critical problems require a command response from an decisive, authoritative figure. Senior midwives are judged by their command abilities and technical competence in a crisis. “Good in an emergency” is the ultimate accolade; “flakey” and “not robust” the ultimate put-downs.
Grumpy Midwife reckons that a busy labour ward probably has just one or two genuinely critical problems a day – and lots and lots of tame ones. She thinks therein lies the issue of bullying: such is our love affair with crisis that every problem is treated as critical and handled thus; brusquely, briskly, with little time for civility, compassion, or questioning of self or others. 
The result is a pervading sense of crisis, a nagging undertone of anxiety, vague unease – or downright misery if you’re one of the less “robust”. All rather exhausting. And unnecessary.

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