A grounded theory study on midwifery managers' views and experiences of implementing and sustaining continuity of carer models within the UK maternity system.

Current NHS policy recommends the transition of maternity services towards providing Midwifery Continuity of Carer (MCoCer) models in order to provide quality care for women and their families in the UK. It is known from the literature that quality of care received in the NHS is correlated with the quality of the management. There is no known evidence available for midwifery managers in how to implement and sustain MCoCer through leadership and midwifery management. The aim of this study was to develop a theoretical framework that is practical and pragmatic, based on the views and experiences of experienced midwifery managers in how to implement and sustain MCoCer models of care within the NHS. Semi-structured interviews were conducted with five experienced midwifery managers to elicit views and understanding of the social processes underlying the implementation and sustaining MCoCer. The interviews were manually transcribed and categorised using Charmaz’s grounded theory approach which acknowledges the experiences of the researcher. The focus codes were developed into theoretical codes. A core category then emerged. The study produced a theoretical framework, which identified that there are pre-requisites from the skills and attributes of the midwifery manager, in order to achieve meaningful leadership of midwifery in MCoCer models. Midwifery managers require a philosophical underpinning of belief in woman centred care and non-hierarchical transformational management skills, alongside the courage to assimilate alternative models of care within the traditional NHS structure. They need to have the capacity to promote and protect the MCoCer model within the service, whilst forming a culture that is based on a woman centred approach. This can be achieved through mastering the development of a values-based recruitment and retention policy and through encouraging midwives with previous experience in MCoCer models to develop leadership skills. Through these leadership strategies, the MCoCer model can be encouraged and protected within the service. MCoCer models are sustainable within the NHS when there is support from the midwifery manager with the appropriate aptitude, skills and attitudes. Managers who have experienced working within a MCoCer model have an insight into the intricacies of the relationships made between women and midwives and the group practice of midwives. Providing the appropriate support for MCoCer is time consuming and personally demanding for midwifery managers; however, this was shown to be rewarding, bringing meaning to their midwifery career