Introduction to leadership and culture

Compassionate and inclusive leadership and culture is essential for both patient safety and staff wellbeing.

A safe and effective workplace culture is marked by openness, staff empowerment, continued learning and improvement. It is vital that risks and challenges within maternity services are recognised and prioritised at Board level.

We found good and outstanding services had an open culture where challenge was accepted.

These services prioritised information sharing between staff and managers to reduce risk. This included information sharing of meeting minutes, learning from incidents, and safeguarding information.

We found that good decision making stemmed from:

• consistently addressing issues in a timely way
• strong succession planning
• transparency from leadership teams
• stability in leadership teams
• approachable leadership
• acting swiftly on identified risk
• driving continual improvement.

However, our findings revealed some examples of suboptimal leadership and culture.

We identified issues that led to:

• poor leadership, including failure to collect and analyse reliable data
• instability within the leadership structure across the trust
• repeated instances of failing to address risks raised by staff and a lack of access to senior decision makers when needed.

Not all services had board-level oversight of service-level issues. Some services did not have an open culture in which staff and service users could voice their concerns without fear. Staff were not always confident that leaders would address concerns they had raised, and staff did not always feel listened to. We discuss this in our National review of maternity services in England 2022 to 2024.