Maternity case study (from ‘Specialties in Practitioner Performance Advice cases’)

Insight report resource

Maternity and team review case study: Fear, resistance and divisions in a maternity team following clinical incidents

This illustrative case study is adapted from our more detailed learning resource.

Read full Insights publication ‘Specialties in Practitioner Performance Advice cases: Key themes and use of our services’.

Features of the case

The management of three clinical incidents had led to division and poor team cohesion in a team of consultant obstetricians and gynaecologists. There was a climate of mistrust with anonymous clinical concerns previously shared with the CQC. The issues were complex and deeply rooted, with one participant describing it as the most dysfunctional team they had worked in.

The poor team working presented a clear clinical risk to patient safety and attempts by the trust so far had failed to resolve matters.

How did Advice respond?

The Advice service were approached to carry out a team review to clarify and communicate the net effects of the difficulties, explore the broader organisational context to the issues and set out options for change.

This review consisted of each team member completing a questionnaire anonymously, followed by a semi-structured interview with two reviewers, to understand the various views of individuals on the function of the team and the issues impacting it.

From the questionnaire and semi-structured interview the reviewers found the key issues affecting the team were:

  • a divide in the team between the longstanding and newer appointee consultants, creating a de facto hierarchical structure and ‘in and out groups’
  • fragmented and irregular communication between these two groups and poor behaviour exhibited at MDT and Consultant meetings
  • a lack of confidence in the trust’s handling of clinical capability concerns, particularly with regard to previous incidents
  • concerns that job plans were not equitable across the team and the job-planning process lacked transparency

The report also set out options for change for the trust which included:

  • more regular structured meetings with the whole consultant team encouraged to attend and contribute to decision-making by consensus
  • an internal review of the clinical governance framework to ensure it set out a robust and transparent approach to the management of concerns, with the outcome communicated to the team
  • an internal review of job plans to ensure the service was appropriately resourced and there was not an over-reliance on excessive programmed activities

What was the outcome?

The summary of themes were shared with the team, who were given the opportunity to feedback on the issues highlighted. There appeared to be common agreement across the team that the report captured the key issues, with some willingness to support measures to address them.

In a follow-up call with the trust two months after the team review was concluded, the Advice service was informed that structured, regular team meetings had been established, with alternated scheduling so all members of the team could attend on a regular basis. Whilst this had only been in place for a short-period of time, early signs suggested it was providing a useful channel of communication across the whole team. The Advice service suggested that if issues with communication persisted amongst individuals, it could offer further support through a facilitated discussion or assisted mediation.

Steps had been taken by the trust to begin a review of job plans across the team, a process which the trust was keen to carry-out as transparently as possible. This would be part of a wider change programme, which the trust had sought external support to lead, and which would also encompass a review of governance structures. With these measures the team were said to be optimistic that there concerns were being taken seriously.

Following delivery of the team review, the Advice service remained available for ongoing support and guidance as the trust continued to build on the positive progress made.

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