Having meandered around the jobs market for a long time before coming to midwifery I’m quite used to the phrase “good at working in a team”. In many a job interview I’ve bleated on about good communication skills and respect for others.
NHS job adverts always request good team workers – it’s probably on some HR template for the whole world – and there’s a lot of literature about the importance of good teamwork in healthcare. So I’m quite shocked at how poorly my unit works as a team compared to, say, the telecoms company I used to work for. Which is unfortunate, as team work is probably more vital when resuscitating a haemorrhaging woman than when you’re trying to increase your sales for calls to Pakistan. The problem is, the barriers to working as a team are massive.
One problem is the sheer number of different people working around you. To cover all shifts many people are employed and you only ever meet a few at a time. So it takes a long while in a large unit to get to know people well, and everything is a lot easier when you feel comfortable with co-workers. That’s why in the private sector companies are prepared to pay to let you have the day off work to climb up a telegraph pole and play trust games. I have always scoffed at ‘team-building’ but I think if I had ever built a bridge out of spaghetti with one of my scariest labour ward co-ordinators then I might be more comfortable saying to her, “I’m a bit worried about the fetal heart rate, would it be ok to come and support me for a few minutes?”.
There is no money, of course, for jolly awaydays, and in some ways they would be superfluous anyway. At the end of a particularly badly-staffed shift when several disasters have only just been avoided, you often feel a strong bond with your fellow workers – hugging and clinging to one another like survivors of a shipwreck as you leave the hospital. But the next shift may be with a completely new set of people.
And I only get that kind of bonding with other midwives – our teams are multi-professional, and include obstetricians, anaesthetists, paediatricians and health-care assistants, as well as other departments in the hospital, like the special-care baby unit or blood transfusion. And we really don’t communicate well with each other. We have our own tribal allegiances and although we all want what’s best for a woman and her baby we have slight differences in focus.
There is a complicated eco-system of different hospital specialities that I could go on about forever. I just want to consider the dynamic between midwives and obstetricians. On just a basic level of communication it doesn’t help that we don’t even share the same staff room. Midwives and health-care assistants slide off to one room while doctors go to another. In my imagination theirs is covered with oak panelling, has old chesterfields and vintage sherry. Probably not, but after many years I still don’t know as I’ve never been inside. It was quite a few years in when I actually found the door to it, like some sort of magical room in Hogworts.
If there’s one easy improvement to team relations, it would be getting rid of the ridiculously outdated hierarchy. I remember surprise at my mother’s stories about the formality of her workplace in the 1950s – definitely no first names. I never imagined I would have to refer to anyone as Mr Something in the twenty-first century, which is how everyone speaks to consultants. I can’t feel that comfortable working with someone when I feel I’m addressing them using language out of Mad Men. It’s like I’m role-playing some very specific fantasy, “Ooooh, Mr Kenny I’ve been such a naughty girl and let my woman haemorrhage everywhere – would you prescribe me some tranexamic acid IV?”.
And don’t get me started on why the hell they are called Mr and not Dr. I think something weird and obscure to do with barber surgeons in the 16th century. Yep – honestly, 500 years ago and they still haven’t dropped it. I may be waiting some time for a complete reform of the hierarchy.