Clinical leadership in the labour

ward

Solange Mianda
25 AUGUST 2016

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 Background to the study
MDGs 4 & MDG 5

After the 8 MDGs, we are offered 17 "Sustainable

Development Goals.

SDG 3: to ensure healthy lives and promote well-being for all

at all ages.

SDG target by 2030:

Reduce the global MMR to less than 70 per 100,000 live births
Ensure universal access to SRH services, including for FP

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 Background to the study
A study by WHO on Maternal and Newborn Health
showed that high coverage of essential interventions
was not associated with reduced MMR

Furthermore high coverage but poor quality (SA)

Conclusion: coverage of interventions must be
matched with overall improvements in quality-of-
care.
Therefore to reach SDG 3, there is need to address
quality of health care.

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 Background to the study
High maternal mortality associated with poor quality of care
and lack of leadership
In District hospitals avoidable factors related to health
providers e.g. poor assessment & poor adherence to
protocols of management leading maternal mortality
Prompting the call for strong leadership at the point of care.
Strengthening leadership at the point of care is
recommended for it potential to improve quality of care
District Clinical Specialist Teams (DCST) appointed to
improve maternal & child health
Provide clinical leadership &
Promote clinical governance in district hospitals

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 Background to the study
DCSTs provide clinical leadership to frontline labour ward
staffs in district hospitals

However the clinical leadership required in the labour ward is

not fully described

Thus the study was design to explore the conceptualizations

of clinical leadership in the labour ward

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 Aim & methods
Aim: describe conceptualizations clinical
leadership at the point of care

Method overall study design grounded theory

Data collection: interviews with ADM DCST
Workshop with ADM DCSTs, OM, provincial
representatives and academic involved in midwifery
training

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 RESULTS

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 What is clinical leadership
Delivery of quality services

-Measurable (supported by data)

-Reliable (same standard of care regardless of
where, who or when provided)
-Sustainable over time
-Standardized (use of protocols for management)
across systems e.g. provision of newborn care
should be the same across levels

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Qualities and competence of clinical
leaders
Qualities Skills
Confidence - Clinical skills &
Assertiveness knowledge
Approachability Communication
Visibility (hands-on) Team building
Resilience Critical reflection
Role modelling Decision making
Accountability Supervision
Up-to-date Mentoring
Motivator

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Who provide clinical leadership in the labour
ward
Clinical managers

Assistant nursing managers

Operations managers

Clinical facilitators/ team leaders

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Roles and tasks of clinical leaders
Teamwork in the LW
Team building within the
labour ward
Provide clinical support
and clinical guidance
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Creating links with other teams
Build and maintain
relationships with:
Multidisciplinary teams
Referral & referring
facilities
Create opportunity for
sharing information within
beyond the unit
 Roles and tasks of clinical leaders
Managing the service

Resources & staff

Performance management
Management of the environment of care
Stakeholder (patient satisfaction)
Job satisfaction
Managing conflicts
Succession planning

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 Roles and tasks of clinical leaders
Staff development
Induction & orientation
Documented mentoring of new and existing staff
Mentoring agreement/ Mentor-mentee relationship
Clinical teaching
Use of staff portfolio to follow up on staff skills
Create teaching opportunities
Delegate
Use of different approaches (observation, proper ward rounds, role
modelling of guidelines & protocols)
In-service training (BANC, ESMOE)
Clinical supervision

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 Roles and tasks of clinical leaders
Improving the services

Clinical audit
Performance assessment of individual practices
(skills assessment)
Research

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 Barriers to clinical leadership
Lack of skills
Lack of confidence
Lack of preparation for the role
Lack of team work, conflict between professionals
Lack of support & communication (management)
Staff shortage (staff turn-over, staff rotation)
Workload, time constraint
Role confusion, lack of balance between duties
Lack of resources
Low incentive
Negative attitude
Fear of litigation
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 Recommendations
Support from management and colleagues
Conducive work environment
Value clarification workshops to address role conflict
and confusion
Provide clear job descriptions (clinical leadership
roles)
Preparation for the role (prior or on the role)

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 Conclusion
To reach quality care, there is need for effective
clinical leadership

Effective clinical leadership requires clinical

competence & an enabling environment

DCSTs have a role

To develop clinical leaders
Make sure the environment is conducive for clinical
leaders to thrive in their roles

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 Acknowledgments
Dr. Anna Voce
ADM DCSTs
Operations managers
District and provincial representatives
Academic representatives
College of health Sciences

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 THANK YOU

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