gms | German Medical Science

Background: Leadership is associated with job satisfaction, Organizational Commitment (OC), and employee health. Considering the shortage of midwives, OC is a relevant outcome of leadership. Since 2008, the Quality Assurance Directive for Premature and Mature Births has included a requirement, that senior midwives in perinatal centers should have completed advanced leadership training. However, no study exists in the context of inf midwifery in Germany. A study concerning job satisfaction among midwives working in hospitals suggests the transformational leadership (TF) style. Transformational leadership is characterized by an exemplary leader, communication of a shared vision, questioning of assumptions, and individualized staff contact.

Aim: The study aims to present how midwives perceive and evaluate the leadership behavior and skills of the lead midwife and how they envision ideal leadership behavior. It also aims to test for an independent association of TL with OC in a multivariate model.

Methods: This is a quantitative cross-sectional study conducted as part of a master’s thesis. Midwives (formerly) working in hospitals in Germany were surveyed online (N=111) using inter alia the validated “Multifactor Leadership Questionnaire” and the “Organizational Commitment Questionnaire”. The questionnaire was assessed with confirmatory factor-analysis and the data was analyzed descriptively, with correlation statistics, difference testing and multivariate linear regression analysis.

Results: Transformational (0.488<=r<=0.843), team-oriented leadership (rτ=0.681) and advocacy (rτ=0.618) correlate highly with “satisfaction with leader” and are perceived to a medium degree among leaders. Laissez-faire, authoritarian, and destructive leadership are negatively rated and once in a while to sometimes exhibited by leaders. Communicative leadership skills are especially associated with “leader effectiveness” (rτ=0.672). The ideal leader particularly demonstrates “advocacy”, “team-orientation”, and “appreciation”. TL shows no independent association with OC. Significant predictors for OC are “hospital manager’s support for the department” (β=0.375), “work-related stress” (β=-0.210), and “team atmosphere” (β=0.180).

Relevance: The study provides first evidence of the leadership behaviors exhibited by senior midwives in the clinical context and for the way these are perceived and evaluated by midwives. Further need for longitudinal studies with larger numbers of cases and a suitable instrument to survey leadership behavior becomes apparent. A gap in research is revealed on the topic of leadership from the perspective of senior midwives, which, according to written comments from participants, presumably needs improvement.

Conclusion: Compared with results from studies in Germany, among others in nursing, TF and the OC of the guided fall low, which calls for action. Regarding the OC of midwives working in hospitals, the importance of hospital management support, team atmosphere, and reduction of work-related stress is demonstrated.

Ethics and conflicts of interest: A vote on ethics was obtained. The research was supported by external funding. There are no conflicts of interest.