Table 4.
Managing conflicts and speaking up from the different professional perspectives.
| Speaking Up: Addressing Safety Concerns | |||
|---|---|---|---|
| Midwives | Physicians | ||
| I think that, at the senior physician’s, the responsibility is almost transferred, whereby I think we still have to share the responsibility, because if something goes extremely wrong and I have recognized that, but have not expressed it, then not legally, but emotionally, so then you’ll think if maybe you would have expressed your opinion and could have taken it into another direction. Well, I think with the young doctors it’s more difficult in terms of responsibility because maybe I have more experience and I think that you have to say this. And to the senior physicians, it’s really a big obstacle to say: I see it differently and what do you think about doing it this way? It’s not always that easy, it depends on the type of doctor, different doctors, of course (TN3Midwife). Well, the doctors have studied for a long time and are senior physicians and have perhaps already done their own research, so in this situation, I find it quite difficult to speak up and to intervene with my opposing assessment, mainly because I don’t know whether it really helps, or whether it finally complicates things (P20Midwife). |
But when I see problems, I have to keep them in my mind until the end until I have actually solved them in the end. Yes, and everyone can say, ‘you see it wrongly, we do it our way, but then I would like to say: ok, then do it without me, until the end. Yes, but when I am called in the end (…) then it’s my problem (P9Physician). I think that sometimes the younger midwives don’t dare to give their point of view, which is probably right, because they think the doctor is older, more experienced or has to make the decision right now and we sometimes don’t oversee it and maybe we just don’t question. And I don’t know much more than the midwife. (…) And we young residents feel sometimes more restrained with our opinion and just don’t communicate. It’s just in your head and you don’t say it out loud (P18Physician). Of course, there are situations where you have the feeling that if a very experienced midwife now suggests something, that you might not be in a position to disapprove (P15Physician). |
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| Dealing with uncertainty and conflicts: Peer and leadership support | |||
| Midwives | Physicians | Nurses | |
| I ask my colleagues. Or I ask the junior colleagues because they know things better from theory (P6Midwife). In the early or late shift, to call a doctor is no problem (...). If it is 4 a.m. and I know he is sleeping and I am just a little bit unsure, I feel more uncomfortable calling him. Well, it is shift-dependent, it is a bit doctor-dependent and of course related to the different cases (P5Midwife). It developed over time that we dare to approach the leadership. I know that the residents do not yet dare to go to the management if there are problems, and we midwives are already a bit tougher because we (…) cannot always assert ourselves on our own (P3Midwife). |
It is a great advantage that one can ask a lot, in any case, (...) especially as a beginner, i the first job, the first experience you gain; if you somehow get the feeling that you can’t ask everyone, I imagine that this would be very demanding. So, I was glad that it was always possible (P15Physician). (...) often after the shift, you discuss it again; (…) often during the situation, unfortunately, this is not possible, because the telephone rings or something else comes in between (…). With the midwives, it is sometimes more difficult because when they have an earlier shift change than we have, you don’t see them until a few days later, then the debriefing is not so immediately possible (P4Physician). |
Well, it’s very important that I can say that something happened to me and that I do not have to be afraid of the hierarchy. (…) Everyone has different abilities. Well, I don’t know anything. There are people who know some things much better than I do. And they should be able to apply it accordingly (P8Nurse). And sometimes you don’t even dare to ask something because you see that it is not welcomed (P16Nurse). |
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| When conflicts arise, there is always the possibility for a conversation, that’s what we are looking for. Thus, if I see such situations, then in any case the conversation is sought (…). If several individuals are affected, then a case is of course also discussed in the team (P7Midwife). | For me it’s clearly a responsibility depending on the leadership position; simply, one implements and exemplifies it from top to bottom. I think the more one just does it, the more it will be continued by the required groups of people (…) doctors with midwives interdisciplinary (P1Physician). | We also had some difficulties; now we have a working group with individuals from the ward and the delivery room. We discuss with our team leader what we did not like, so things work a bit better (P11Nurse). | |