The evaluation of the implementation of the new model of clinical supervision for midwives in Scotland: a qualitative study

Abstract

Background: A public inquiry into failings in maternity services and care in England (Kirkup, 2015) identified that the dual roles of midwifery statutory supervision, namely support and regulation, should be separated. As a result, support was to be delivered by introducing new clinical supervision models provided by employers of midwives, and regulation was the sole responsibility of the Nursing and Midwifery Council. The new model of clinical supervision in Scotland was launched in 2018 after statutory supervision of midwives ended in 2016, and this study evaluated its implementation and midwives' participation in the new model.
To begin the study, a systematic review of the literature was completed, which identified that no empirical research existed about the new model of clinical supervision, how it was implemented or midwives’ experiences of participating in it.

Aims: To understand and analyse midwives’ participation in the new model of clinical supervision in Scotland and how this new model was implemented.

Methods: A qualitative case study design was used to evaluate Scotland's new model of clinical supervision. Purposive sampling and snowballing strategies were utilised to select midwife participants who had participated in clinical supervision. In-depth semi-structured interviews were conducted at 1) a meso-level with ten Heads of Midwifery in ten NHS Health Boards and 2) at a micro-level with eighteen midwives in two case sites. Additionally, four non-participant observations in the two case sites were completed. A theoretical framework was used to design and present the study using four of Proctor et al.’s (2011) implementation outcomes, acceptability, adoption, feasibility, and fidelity. In addition, framework analysis (Gale et al., 2013) was used to analyse the generated data.

Findings: The findings identified three main factors 1) time, 2) trust, and 3) perceptions of clinical supervision as a tick-box exercise were the main barriers to implementing clinical supervision and midwives’ experiences of participating in it. First, the time available to prepare for and participate in clinical supervision was limited. As the new model was delivered predominantly in groups, participants were affected by a lack of trust in groups which affected their participation. Finally, clinical supervision was perceived as an item to ‘tick off’ to evidence attendance.

Conclusions: This study revealed that the acceptability of the new clinical supervision model was affected by how it was delivered and the content of the new model, especially reflection and resilience-building. The adoption of the new model was impacted by how often midwives participated in clinical supervision, which was affected by advertising and promotion, and the simultaneous implementation of a major new midwifery policy, Best Start (Scottish Government, 2017). Significantly, the previous model of statutory supervision influenced midwives’ engagement with and the uptake of the new clinical supervision model. Clinical supervision was considered a feasible intervention, although its feasibility was affected by midwives’ feelings and emotions related to participation and the lack of resources available to deliver the intervention. Finally, midwives showed varied understanding of the new clinical supervision model, which altered the ability to adhere to and deliver clinical supervision as intended.

Keywords: Midwives, Clinical, Supervision, Statutory, Support, New, Performance, Case, Protection, Public, Practice, Acceptability, Adoption, Feasibility, Fidelity

Date of Award	2022
Original language	English
Sponsors	Chief Scientist Office
Supervisor	Alison McFadden (Supervisor), Joan Cameron (Supervisor) & Nicola Gray (Supervisor)