SLIDE 1 INTRODUCTION

INTRODUCTION: This presentation aims to delve into the issue of staff retention within the
Maternity department of our primary healthcare facility. It will encompass an examination of our
team's structure, a clear definition of staff retention, an analysis of relevant theoretical frameworks,
considerations of organizational structure and culture, leadership styles, the importance of teamwork,
and the principles of ethical leadership. Each concept will be thoroughly explained and linked to its
significance in enhancing staff retention. While real-life workplace examples will be utilized,
confidentiality will be maintained in accordance with the NMC code of practice (NMC, 2018). Given
the limited emphasis on understanding the reasons behind the high turnover of midwives in our
maternity department, this presentation will draw heavily from existing research on midwives in
general.
The retention of skilled nursing professionals, such as midwives in the maternity department is crucial
for delivering top-tier patient care (Bashar et al., 2022). The issue is poor remuneration and work
conditions which affect the staff retention at the maternity department . Based on data from 9 salaries,
an early career midwife with 1-4 years of experience can expect to earn an average of ₦660,000. For
mid-career midwives with 5-9 years of experience, the average salary based on 6 salaries is
₦320,000( Payscale,2023).In comparison, the average salary of a midwife in the United Kingdom is
£17.03 per hour or £33,209 per year (Serapelwane and Manyedi 2022). While the staff retention rate
in the UK showed differences due to age. Between 2019 to 2020, the retention rate was 96% for
midwives aged 18 to 34. While it was 91% for midwives aged 51 to 60 years (Reddy et al., 2022). The
chosen organisation is the maternity department in the primary healthcare sector. It is a public sector.
Bogren et al. (2020) state that from a leadership and management perspective, the management must
make the staff stay in the hospital to provide optimal patient care. It keeps the organizations running.
Further, leadership modalities have an essential role in managing the staff and the organization.
Therefore, from the perspective of leadership, by controlling a staff-friendly environment and a safe
working environment space is created. Washeya and Fürst (2021) emphasised that by satisfying the
staff, the ultimate improvement is seen in the delivery of patient-centered care and application of
standard protocols at the center, resulting in better patient outcomes. The leadership style followed by
my organisation is democratic leadership which is a top-to-bottom hierarchy system (Serapelwane and
Manyedi 2022). The management and authority come first, then other employees follow but in the
maternity department, it is headed by the apex nurse who is a midwife, then the officer in charge who
is also a midwife, other registered midwives and nurses. . This promotes collaboration, participation,
and decentralized decision-making (Kamvura et al. 2022)
SLIDE 2 TABLE OF CONTENT
SLIDE 3 ORGANISATIONAL STUCTURE
The leadership style followed by my organisation is democratic leadership which is a top-to-bottom
hierarchy system (Serapelwane and Manyedi 2022). The management and authority come first, then
other employees follow but in the maternity department, it is headed by the apex nurse who is a
midwife, then the officer in charge who is also a midwife, other registered midwives and nurses. . This
promotes collaboration, participation, and decentralized decision-making (Kamvura et al. 2022)

SLIDE 3
According to Bashar et al. (2022), in organisational studies, the cornerstone concepts are management
and leadership which make the organisation a success or failure. Optimal leadership ensures it
influences, inspires, and guides the staff members to achieve a shared goal. Morison (2023) states
that management is the coordination in the execution of tasks and cooperation in making the changes
happen in the department to achieve optimal care delivery of the patient. both of these concepts are
significant in organizing the healthcare sector effectively.
Ideal leadership and management ensure that issues such as remuneration are not raised. Reddy et al.
(2022) state that inadequate compensation and payment for the work done by the employees result in
the staff leaving the organization and going to some other organization where they are treated well.
Further, the distinction between management and leadership can be made from the orientational
process. Ebenso et al. (2020) state that leadership is for the people, while management is for the
process that involves the staff. Through optimal leadership, the staff is trained to carry out the process.
Leaders of the organization empower the staff to foster innovative ideas and navigate changes that are
needed in the healthcare system. This is supported by He et al. (2020), who state that the leaders
enable the staff to share a common goal; they motivate their team and staff members to achieve that
goal by encouraging them to create adaptive responses for the upcoming challenges in the maternity
department at the primary healthcare centers. In contrast, Serapelwane and Manyedi (2022) state that
managers prioritize, plan, and control all the resources available to run the organisation smoothly. The
managers enforce the procedures, establish systems, and monitor the performance to assess if the
organisation needs a change.

SLIDE 5 PREVAILING LEADERSHIP STYLE

In the maternity department at the primary healthcare center, the democratic leadership style is being
followed in which the staff is encouraged to actively participate in the multi-disciplinary team (MDT)
approach to providing care to the patients (Girma et al. (2021). However, the staff is not being
compensated for the work they do in MDT. This has resulted to high attrition of midwives. Although
this approach has fostered a culture of inclusivity where the decisions for the patients are being taken
collectively by assessing the input from the stakeholders as emphasised by Muluneh et al. (2022), the
staff is not being compensated the rightful amount they deserve for the job. Therefore, the staff feels
burnout.
As stated by Manda et al. (2023) through a democratic leadership style, the team members work
cohesively, and their morale is empowered by fostering a sense of ownership in the organization.
Further, it promotes creativity and innovation of the staff. This is supported by Girma et al. (2021),
who believes that in a democratic leadership style, the staff is empowered to make decisions. By
working through a democratic leadership style, the patients are satisfied as better patient outcomes are
supported by MDT as emphasised by Mothwane (2020). Hence, the same democratic leadership style
can be used to solve the recent issue at the staff level about remuneration in the organization by
enabling open discussion and collaboration to find the solution to the problem. This will lead to the
fair compensation which the staff deserves. This leadership style supports the work of the team..
Remuneration can have both positive and negative effects on teamwork depending on different factors
such as fairness, compensation, adequacy, and alignment with the expectations of the staff
(Serapelwane and Manyedi 2022). Shikuku et al. (2022) suggested that when the remuneration is
competitive, aligns with the expectations of the employee, and is fair, it impacts teamwork positively
by promoting motivation, collaboration, and satisfaction in the staff members. However, as proposed
by Kamvura et al. (2022) if remuneration is inadequate and unfair the staff becomes dissatisfied, and
demotivated, there are conflicts, and it affects the team negatively. Thereby, affecting the performance
and productivity.
Recently, the democratic leadership style has contributed to the organization's output of providing
better and optimal care in the establishment.. However, if other leadership styles have been
considered, such as transactional leadership, the focus would have been on the rewards and
punishments of the work done by the staff instead of job satisfaction in democratic leadership style as
emphasized by He et al. (2020). Lastly, the democratic leadership style has shown effective results in
satisfying the patients and producing optimal organizational outputs. By involving the team members
in MDT, the democratic leaders have ensured that the needs of the patients must be prioritised. This
aligns with the Nursing and Midwifery Council (2018), which emphasises prioritising the patient as it
is an essential P out of the 4Ps of nursing. It also emphasises that combining two or more different
leadership styles can help the leader to manage the staff more effectively, resulting in higher rates of
staff retention.

SLIDE 6 IMPACT OF DIFFERENT LEADERSHIP STYLES

Identifying the needs and changes needed in leadership style and in the management process is
crucial for any organization, as emphasized by Muluneh et al. (2022). The need for change
necessitates analysing the organization's current dynamics, objectives, and culture. Serapelwane and
Manyedi (2022) state that for evaluating the change, an assessment is conducted, feedback from the
stakeholders is taken, the performance is appraised, and benchmarking is done against the hospital
standards. Following these methods identifies the need for change in the gap between leadership
competency and management practices. This helps in determining the strategies to be taken for the
future, too. In the maternity department at the primary healthcare center Kurt Lewin’s model of
change is used to make the changes if needed. This model is chosen for driving change in the system
because it is simple and concentrates more on the problem as compared to the Kotter’s model of
change which has many steps as emphasized by Muluneh et al. (2022). Different leadership styles
affect the work of the team and their level of productively within a certain organizational structure as
emphasized by Serapelwane and Manyedi (2022). For example, the autocratic leadership style
characterized by its focus on decision making and empowering patient autonomy reduces creativity
and morale and, thereby, job satisfaction among the staff members, as emphasized by Shikuku et al.
(2022). However, Kamvura et al. (2022) state that the democratic leadership style fosters active
participation through shared-decision making and empowerment, resulting in team cohesion and
innovation in the organizational process. Hence, in the maternity department at the primary healthcare
center innovation and team cohesion are promoted too which enhances productivity. Besides, the
transformational leadership style inspires and motivates the team members to compel the vision and
personal charisma by driving a higher level of performance and engagement as emphasised by Hamid
et al. (2023). Nevertheless, in highly regulated organisations, the transactional leadership style is
followed. It focuses on the rewards and punishments of the staff performance. This affects
productivity positively as the staff tries to perform better. This style also limits the autonomy of the
staff and hinders intrinsic motivation (Mothwane, 2020). Therefore, the choice of leadership style
must be always according to the objectives of the organisation, its needs and culture to optimise the
team performance and productivity (Manda et al. 2023).

SLIDE 7 THEORITICAL FRAME WORK /THEORIESThe theoretical framework for governing the
structure of the maternity department is drawn from organizational theories such as systems theory
and Max Weber’s Bureaucracy theory. By adhering to the bureaucratic principles, the maternity
department emphasizes the hierarchical structure of the primary healthcare center, division of labour,
and adhering to the formal rules and procedures as stipulated by Girma et al. (2021). Further, the
system theory guides the approach of the maternity department to view it as an interconnected system,
connected with multiple subsystems such as labour, delivery, antenatal and postnatal care which all
work to achieve the same goals. The goal is to achieve better patient outcomes for the mother before
delivering the baby, during delivering the baby, and after delivering the baby.
Comparatively, the other organisations also follow bureaucratic structure but their system theory
varies such as greater emphasis on the MDT and holistic patient care, aligning more with the NHS
system (NHS, 2024). While, some organisations follow the standard guidelines by NICE, WHO, and
department of the Health and well as the professional standards by the BAPEN (National Institute for
Health and Care Excellence, 2023: BAPEN, 2011: Department of Health & Social Care 2021).

SLIDE 8 MAX WEBERS THEORY

The leadership theory followed in the maternity department at the primary healthcare center is
democratic. While transformational leadership style can be considered as the best fit for the
organisation as it inspires and motivates the staff to do better through compelling vision and personal
charisma (Kamvura et al. 2022). It aligns with a positive work environment and fosters staff
engagement and satisfaction as emphasised by Reddy et al. (2022). However, if democratic leadership
theory is compared with the other theoretical frameworks in other organizations, different leadership
theories can be determined and recognized. In other healthcare systems, the Great Man theory is
applied in which effective leaders are born with innate qualities, contrasting with the trait theory in
which the main focus and characteristic of the leader is charisma and intelligence (Jensen, Lund, and
Abrahams, 2022). Nevertheless, in skills theory, the main emphasis is on leadership behaviour.
Contingency and situational leadership concentrate on adapting to the situation according to the
emergency in the maternity ward as opined by Kamvura et al.( 2022). Hence, each theory influences
how leadership is perceived and enacted within the organisation to shape management practices and
team dynamics (Girma et al. 2021).

SLIDE 9 ORGANASATIONAL STRUCTURE

The organizational culture affects the leadership and organisation both by sharing and reinforcing the
prevailing organisational culture (Aikins et al. 2023). According to Schein’s Organisational culture
model, the values, artifacts, and assumptions guide the culture (Bassey, and Bassey, 2024). However,
in the maternity department at the primary healthcare center, the culture is based on collaboration and
patient-centered care, and democratic leadership reflects that these values, are in practice. This could
have been improved by applying transformational leadership theory in the maternity department at the
primary healthcare center as it supports leaders to be inspired and motivate themselves by sharing
values and pursuing their collective goals (Abe et al. 2021). Conversely, in the hierarchical culture
and autocratic leadership style, the decision-making process is top-down which means that the
innovation is based on staff engagement rather than order coming from the higher authorities.
Therefore, understanding the culture of the organization is essential to show productivity as it shapes
the attitudes, and behaviours of the staff members (Abe et al. 2021).

SLIDE 10 GAP ANALYSIS

In this assignment, for driving change in the maternity department at primary healthcare center the
tool that is used in the future to plan, implement and review the change will be the Gap Analysis
Process (Abe et al. 2021).
In the planning phase, an assessment will be conducted of the current state of the remuneration and
the working conditions in the maternity department. The specific areas of concern such as low salary,
low benefits, and inadequate working conditions will be considered. The feedback of the midwives
and staff will be taken and the performance data will be gathered as emphasised by Girma et al.
(2021). In the implementation phase, the target strategies will be developed based on the identified
gaps in the maternity department. Changes such as enhanced benefit packages, better salaries, and
improved working conditions will be ensured. Lastly, the changes will be communicated to the
stakeholders. Emphasis will be made on the rationale and benefits of the organisation as proposed by
Mothwane (2020). In the review phase, the effectivity of the implemented changes will be monitored
and evaluated by regularly reviewing the process. The impact of the intervention on staff satisfaction,
organisational performance, and retention rate will be counted, and feedback from the staff will be
taken for further improvement as by Manda et al. (2023).

SLIDE 11 TUCKMANS THEORY

Tuckman's (1965) model outlines a team's journey through five development stages: forming,
norming, storming, performing, and adjourning. The first stage, forming, is marked by orientation,
testing, and the establishment of boundaries (Tuckman, 1977). According to Tuckman (1965) and
Gren, Torkar & Feldt (2017), the norming stage marks a transition from singular leadership to a
more open and shared style. During this stage, team members may feel uncertain and seek guidance
while prioritizing harmony to gain acceptance from the group (Kozlowski and Ilgen, (2006, LinkedIn,
( 2022). The primary objective of new employees is to assimilate into the team by engaging in social
interactions and comprehending each other's roles in achieving service objectives (Kozlowski and
Bell, 2013)
The stages of team development, as proposed by Tuckman in 1965, traditionally describe a linear
progression from forming to norming and then performing. However, Hennen (2014) suggests that
teams may undergo multiple stages simultaneously and can regress to earlier stages or become stuck
in one as evidenced in my organisation This concept is particularly relevant in environments like the
maternity department, where team dynamics fluctuate due to staff turnover, leading to cycles of
forming, storming, and norming without fully achieving the performing stage. Kanten et al. (2015)
argue that to reach their goals, teams must adapt to changing conditions. Despite not attaining the
peak performing stage, teams can still function and meet service demands by being adaptable and
flexible. Authors such as Hennen (2014) , Carbonelli (2017), and Mathieu, Hollenbeck, van
Knippenberg, and Ilgen (2017 emphasize the importance of maintaining functional teams, which are
characterized by quality work, goal orientation, cohesion, productivity, and overall success.
2/2

SLIDE 12 LEADERSHIP AND MANAGEMENT INTERVENTIONS

Critically evaluating the leadership and management interventions is crucial for implementing the
developmental plans and strategies in the maternity department at the healthcare center, as it is
imperative to the theoretical frameworks. For intervening in the strategies, Kurt Lewins Model is
used, specially designed to bring management changes. It provides a systemic three-step approach to
bring change (Abe et al. 2021). It provides deep insights to unfreeze the existing behaviour,
implement the change, and refreeze the new behaviour. The model is simple and easy to apply without
any complications (Aikins et al. 2023). By applying this model in the maternity department, the staff
can easily assess the effectiveness of the various interventions such as training programs for the
leaders, initiatives by the mentors, and analysing performance management systems in the
organizational change and development (Bassey, and Bassey, 2024). However, another change model
can be used in the maternity department called Kotters’ eight-step model of change (Mothwane,
2020). It provides a systemic approach for initiating and managing organizational change. It
emphasizes the significance of creating urgency, building and guiding the coalition, and
communicating the vision with the team to bring change (Shikuku et al. 2022) effectively.
The organizational change in the maternity ward occurs in response to external or internal pressures,
such as medical technology advancements. The change process involved in the maternity department
combines the top-down and bottom-up approaches in which the leaders communicate the changes
needed, provide input, and collaborate on implementing solutions (Shikuku et al. 2022). The
theoretical frameworks such as the Burke-Litwin Model of organizational change provide insight into
the complex interaction between internal and external drivers for the change (Kamvura et al. 2022).
Through this framework, the leaders of the organization at the maternity department navigate the
changes needed to address the structural needs of the primary health which is staff retention and
reduction of high attrition of staff

SLIDE 13 BARRIERS AND STRATEGIES TO OVERCOME BARRIERS

The challenges and barriers associated with GAP include the stakeholders' resistance to change,
conflicting priorities, and limited resources. Another barrier is the staff members' hesitance to share
their opinions and engage in the assessment process. Further, low budgets are also a constraint in
driving change in the organization (Aikins et al. 2023). The strategies to overcome the barriers are
fostering open communication, engaging with the stakeholders, and providing opportunities for staff
input and involvement (Bassey, and Bassey, 2024). Further, Abe et al. (2021) states that leadership
support, advocacy ensure secure resources and helps in prioritising the initiative by improving the
remuneration.

SLIDE 14 LEADERSHIP ROLES

Ashmore et al. (2021) state that management and leadership both contribute to collaborative
teamwork in the primary healthcare sectors. Through effective leadership, the team members stay
motivated and directed. Meanwhile, effective management ensures efficient coordination by using
optimal resources to achieve shared goals (Wihl et al. 2020). In the context of the poor remuneration,
leadership and management played a crucial role in enhancing staff retention in the maternity
department of the primary healthcare center. Further, the democratic leadership style in the maternity
department significantly impacted teamwork, performance and productivity. Enghiad, Venturato, and
Ewashen (2022) state that through democratic leadership, the team members are empowered, and it
becomes easy to solve problems through decision-making. it is because when the team members feel
that they have been valued, they are more likely to work in a team to achieve a common goal.
However, Wihl et al. (2020) state that different factors facilitate or become barriers to team
performance and productivity in organisations. The same happened in the maternity department,
where factors such as resources, workload, and lack of recognition in the team affected team
performance and productivity. This is supported by Duignan, Drennan, and McCarthy (2021), who
state that in any supportive organization, clear communication is needed for the teams to collaborate
strategically. Further, assessing the team performance in the maternity department requires multiple
approaches, such as evaluation of the indicators of remuneration. These indicators include staff
turnover rate, clinical outcomes, and patient satisfaction scores (Bucnford, Collier, and Greaves,
2023). Further, taking feedback from every member is essential to provide a deeper insight in the team
dynamics and assessing the area for improvement (Enghiad, Venturato, and Ewashen, 2022).
Effective leadership can increase the team's output through a supportive and empowered environment
in which the teams feel valuable and motivated (Enghiad, Venturato, and Ewashen, 2022). It also
aligns with the organizational goals at the maternity department. This is supported by Landers et al.
(2020), who state that open communication is essential for effective collaboration in teamwork,
resulting in innovation, productivity, shared vision and performance. However, McInnes et al. (2020)
state that poor leadership can disturb the working relationships in the working space, such as
healthcare centers. It also threatens the relationship and stability. However, Wihl et al. (2020) state
that micromanaging and authoritarian leadership styles create a culture of resentment and fear among
team members creating issues in the teamwork. Therefore, lack of direction and inconsistent
leadership are associated with conflict and confusion in the workplace. It disturbs the trust and
cohesion within the team as well. This is supported by Duignan, Drennan, and McCarthy, (2021) who
state that leaders who fail to address the individual needs and concerns of the staff members and the
productivity of the team members, do not build productive teams. It leads to dissatisfaction and low
morale among team members. It affects the productivity of the team too.
In the maternity department at the healthcare center, team dynamics can be improved through the
theoretical framework of the transformational leadership style and use of motivational theories like
maslow. It will encourage leaders to inspire and motivate the staff members through personal
charisma and approach to address the problems individually (Enghiad, Venturato, and Ewashen,
2022). This is supported by Bucnford, Collier, and Greaves (2023), who states that by the provision of
high-quality patient-centred care, the team shows personal and professional development. Therefore,
the transformational leadership style is best suited for leaders at healthcare centres. However, Landers
et al. (2020) state that the challenges related to transformational leadership style arise when policy and
structural changes prevent leadership effectiveness. For example, the hierarchal structure and
bureaucratic structure limits the opportunity for the staff members to have an open communication.
This reduces level of empowerment and hinders the ability of the leaders for maximising the team
outputs (Duignan, Drennan, and McCarth

SLIDE 15 ETHICAL AND PROFESSIONAL ROLE OF L;EADERS

Jackson et al. (2021) state that ethics and professionalism are the fundamental aspects of leadership
and help in shaping the decision making process. Hence, it influences the practice of the midwives in
healthcare settings. Further, Landers et al. (2020) state that the leaders are the sole entities who are
responsible for upholding the ethical principles and standards while assessing the complex challenges
for managing the team, and providing financial stability and optimal patient care delivery.
The four important ethical principles in nursing for managing are autonomy, beneficence, justice and
non-maleficence. Wang et al. (2021) state that it is essential for the healthcare staff and nurses to
respect the patient’s rights in having their own decisions. Hence, to address this, the NMC code of
2018 has been followed, in which patients are prioritised by giving them the right to have a say in
their treatment through patient-centered care and shared decision-making (NMC, 2018). For
remuneration and staff retention, it is considered optimal to encourage the staff, acknowledge their
efforts, and pay and compensate them for their work (Adcock, Sidebotham, and Gamble, 2022).
However, in management, autonomy is given to the staff by asking them to have an open dialogue
with the team and share their opinions. This helps in building trust, confidence, and opens ways for
both personal and professional growth. This in return enhances staff retention and decreases poor
remuneration (Hewitt et al. 2022).
Another principle is beneficence, according to which the patients should benefit from the treatment
(Adcock, Sidebotham, and Gamble, 2022). The midwives must always take action and promote the
health and well-being of the mother and child in the maternity department, as Novitasari et al. (2021)
emphasised. Further, by management perspective in the healthcare sectors, the team dynamics and
working must benefit all the team members. Compensating the staff also benefits them and promotes
staff retention (Hewitt et al. 2022).
Further, non-maleficence is also an important ethical principle for managing healthcare centres.
Adcock, Sidebotham, and Gamble (2022) state that in non-maleficence, the harm must be avoided for
the patient, and the risk should be minimised. The same goes for the staff members. According to the
last principle of justice in managing the healthcare sectors, the leaders need to be fair and just with all
the staff members. This in turn promotes staff retention (Papadopoulos et al. 2021).
In the primary healthcare center, the leaders encounter ethical dilemmas while balancing the complex
needs of different stakeholders such as staff, patients, and financial stakeholders (Hewitt et al. 2022).
One of the common dilemmas is related to the allocation of resources such as deciding on equipment,
staffing, funding, and ensuring easy access to maintain and provide quality care to the patients
(Jackson et al. 2021). Further, the leaders face ethical challenges while managing the staff members
such as addressing issues of conflict, promoting just behaviour, and upholding the confidentiality of
the patient (Landers et al. 2020). The greatest dilemma of all time is seeking informed consent from
the patient before including them in the treatment intervention. Usually, informed consent is taken in
person-centered care in which the patient also has a say in his treatment regimen. Informed consent is
also asked of the patient before asking him personal questions that can help develop interventions and
provide optimal care (Hewitt et al. 2022). Nevertheless, Papadopoulos et al. (2021) argue that
informed consent is also important for patients who have disability issues in the maternity ward, and
the nurses take their permission before touching them.
In the maternity department at the primary healthcare center, the leaders experience ethical dilemmas
as well while managing the team members, managing outputs, and asking for financial balance
(Adcock, Sidebotham, and Gamble, 2022). For example, the leaders face the pressure to increase their
productivity and performance and meet the targets of the performance while ensuring that patient
safety is ensured and staffing level is adequate too. According to the NMC Code of 2018, it is
essential to preserve the safety of the patient by not prescribing any medicine that can cause drug-to-
drug interaction. Therefore, the nurses have to be vigilant and provide optimal care while maintaining
the standard protocols (NMC, 2018). However, if this is not maintained, it can cause tension in the
workplace between team members

SLIDE 16 ETHICAL RLOES CONTD Further , the leaders have dilemmas related to financial
sustainability such as confusion in deciding when to invest in the training of the staff and ensure their
development personally and professionally, and when to allocate the resources for improving the
technology and infrastructure at the maternity department (Jackson et al. 2021). Also, it is an ethical
dilemma to balance the competing interests of the stakeholders, including the welfare of the staff,
patient safety, patient confidentiality, patient care, patient satisfaction, team members, and staff job
satisfaction. Therefore, it is essential to align the values of the organisation with the priorities and
ethical terrain of nursing (Hewitt et al. 2022).
Poor remuneration affects staff retention in the maternity department at the primary healthcare center.
Leaders encounter different ethical dilemmas that require optimal consideration and decision-making.
By following ethical theoretical frameworks, guidance to navigate these dilemmas and informed
leadership decisions is ensured. In turn, these help improve patient care and satisfaction (Novitasari et
al. 2021).
One ethical framework known as the principlism approach (Hewitt et al. 2022) is usually applied to
the maternity department at the primary healthcare center. This approach is based on the four
principles known as autonomy, beneficence, justice and non-maleficence (Jackson et al. 2021). It is
optimal for the leaders to assess these principles in the maternity ward while making decisions about
remuneration and different working conditions. For example, ensuring fair and adequate
compensation for the staff members is crucial. It aligns with the principles of beneficence and justice.
It promotes in resolving the issues of financial constraints for the organisation and the need to allocate
equitably across various departments at the hospital. therefore, it balances the justice and beneficence
(Adcock, Sidebotham, and Gamble 2022).
Another influential framework in ethics is virtue ethics according to which the focus is on the morals
and traits of the staff in the healthcare sector (Jackson et al. 2021). In this framework, the leaders in
the maternity department draw virtues such as integrity, compassion, care, and justice, while
addressing the issues of remuneration. For example, demonstrating empathy towards the members of
the team at the primary healthcare center can help the leader reflect on this practice and motivate him
to be fair and compassionate at the same time (Papadopoulos et al. 2021). Furthermore, according to
the utilitarianism ethical theory leaders consider remuneration and working conditions in an
organisation. According to this principle, the actions of the staff members must be evaluated before
deciding if they should not be compensated for the job they are doing (Novitasari et al. 2021). In the
context of the maternity department at the primary healthcare sector, the leaders must assess the
benefits of investing in the working conditions such as the staff morale and retention rate, against the
cost of the implementation (Adcock, Sidebotham, and Gamble, 2022). Hence, by adopting to this
perspective, the leaders will aim for the broader consequences of their actions.

SLIDE 17 NO WRITE UP

SLIDE 18 ETHICAL DECISION MAKING

Further , the leaders have dilemmas related to financial sustainability such as confusion in deciding
when to invest in the training of the staff and ensure their development personally and professionally,
and when to allocate the resources for improving the technology and infrastructure at the maternity
department (Jackson et al. 2021). Also, it is an ethical dilemma to balance the competing interests of
the stakeholders, including the welfare of the staff, patient safety, patient confidentiality, patient care,
patient satisfaction, team members, and staff job satisfaction. Therefore, it is essential to align the
values of the organisation with the priorities and ethical terrain of nursing (Hewitt et al. 2022).
Poor remuneration affects staff retention in the maternity department at the primary healthcare center.
Leaders encounter different ethical dilemmas that require optimal consideration and decision-making.
By following ethical theoretical frameworks, guidance to navigate these dilemmas and informed
leadership decisions is ensured. In turn, these help improve patient care and satisfaction (Novitasari et
al. 2021).
One ethical framework known as the principlism approach (Hewitt et al. 2022) is usually applied to
the maternity department at the primary healthcare center. This approach is based on the four
principles known as autonomy, beneficence, justice and non-maleficence (Jackson et al. 2021). It is
optimal for the leaders to assess these principles in the maternity ward while making decisions about
remuneration and different working conditions. For example, ensuring fair and adequate
compensation for the staff members is crucial. It aligns with the principles of beneficence and justice.
It promotes in resolving the issues of financial constraints for the organisation and the need to allocate
equitably across various departments at the hospital. therefore, it balances the justice and beneficence
(Adcock, Sidebotham, and Gamble 2022).
Another influential framework in ethics is virtue ethics according to which the focus is on the morals
and traits of the staff in the healthcare sector (Jackson et al. 2021). In this framework, the leaders in
the maternity department draw virtues such as integrity, compassion, care, and justice, while
addressing the issues of remuneration. For example, demonstrating empathy towards the members of
the team at the primary healthcare center can help the leader reflect on this practice and motivate him
to be fair and compassionate at the same time (Papadopoulos et al. 2021). Furthermore, according to
the utilitarianism ethical theory leaders consider remuneration and working conditions in an
organisation. According to this principle, the actions of the staff members must be evaluated before
deciding if they should not be compensated for the job they are doing (Novitasari et al. 2021). In the
context of the maternity department at the primary healthcare sector, the leaders must assess the
benefits of investing in the working conditions such as the staff morale and retention rate, against the
cost of the implementation (Adcock, Sidebotham, and Gamble, 2022). Hence, by adopting to this
perspective, the leaders will aim for the broader consequences of their actions.

SLIDE 19 LEADERSHIP AND MANAGEMENT TECHNIQUE

Further , the leaders have dilemmas related to financial sustainability such as confusion in deciding
when to invest in the training of the staff and ensure their development personally and professionally,
and when to allocate the resources for improving the technology and infrastructure at the maternity
department (Jackson et al. 2021). Also, it is an ethical dilemma to balance the competing interests of
the stakeholders, including the welfare of the staff, patient safety, patient confidentiality, patient care,
patient satisfaction, team members, and staff job satisfaction. Therefore, it is essential to align the
values of the organisation with the priorities and ethical terrain of nursing (Hewitt et al. 2022).
Poor remuneration affects staff retention in the maternity department at the primary healthcare center.
Leaders encounter different ethical dilemmas that require optimal consideration and decision-making.
By following ethical theoretical frameworks, guidance to navigate these dilemmas and informed
leadership decisions is ensured. In turn, these help improve patient care and satisfaction (Novitasari et
al. 2021).
One ethical framework known as the principlism approach (Hewitt et al. 2022) is usually applied to
the maternity department at the primary healthcare center. This approach is based on the four
principles known as autonomy, beneficence, justice and non-maleficence (Jackson et al. 2021). It is
optimal for the leaders to assess these principles in the maternity ward while making decisions about
remuneration and different working conditions. For example, ensuring fair and adequate
compensation for the staff members is crucial. It aligns with the principles of beneficence and justice.
It promotes in resolving the issues of financial constraints for the organisation and the need to allocate
equitably across various departments at the hospital. therefore, it balances the justice and beneficence
(Adcock, Sidebotham, and Gamble 2022).
Another influential framework in ethics is virtue ethics according to which the focus is on the morals
and traits of the staff in the healthcare sector (Jackson et al. 2021). In this framework, the leaders in
the maternity department draw virtues such as integrity, compassion, care, and justice, while
addressing the issues of remuneration. For example, demonstrating empathy towards the members of
the team at the primary healthcare center can help the leader reflect on this practice and motivate him
to be fair and compassionate at the same time (Papadopoulos et al. 2021). Furthermore, according to
the utilitarianism ethical theory leaders consider remuneration and working conditions in an
organisation. According to this principle, the actions of the staff members must be evaluated before
deciding if they should not be compensated for the job they are doing (Novitasari et al. 2021). In the
context of the maternity department at the primary healthcare sector, the leaders must assess the
benefits of investing in the working conditions such as the staff morale and retention rate, against the
cost of the implementation (Adcock, Sidebotham, and Gamble, 2022). Hence, by adopting to this
perspective, the leaders will aim for the broader consequences of their actions.

RECOMMENDATIONS
The recommendations for enhancing the style of the leadership impact on the service provision is to
foster a culture of open communication, involve feedback, one-on-one discussions, anonymous
feedback system, and open dialogue can ensure that every voice is heard. This promotes staff
satisfaction, leading to personal and professional development and higher staff retention rates
(Rehman, and Iqbal, 2020). Further, another recommendation is to invest in leadership development
by going on the training, workshops, seminars, and work on conflict resolution, and letting the juniors
speak instead of dictating. This in turn promotes staff retention (Harvey et al. 2020). Moreover,
another recommendation is to empower the staff and provide them autonomy for maximising the
impact of leadership. It leads to innovation in the healthcare system and promotes personal and
professional development, leading to staff retention (Halkias, and Neubert, 2020). Further, leading by
example, recognising and rewarding excellence along embracing diversity are some other key
recommendations for increasing staff retention rates (Christoffersen, Teigen, and Rønningstad, 2020:
Ngabonzima, Asingizwe, and Kouveliotis, 2020)

CONCLUSION
To conclude, effective leadership is crucial for the organization's success, especially for enhancing
service provision. Throughout this assignment, the emphasis has been on the critical role of the
leaders in shaping the culture of the organisation, fostering staff engagement and collaboration in
MDT, driving change, and promoting innovations. Hence, by prioritising open communication and the
development of the leader, the staff can be promoted, empowered, and given autonomy. This enhances
staff retention. However, the hierarchical system in the democratic leadership style does not promote
staff retention but keeps the communication gap at different levels of the organisation. In the
maternity ward, the staff is not well compensated for the job they do. The leadership style is also
democratic, leading to a low or partial positive impact on staff retention. Therefore, leading by
example, being just, and fair, is essential for the leader to promote staff retention. From an ethical
perspective, the leaders can benefit the staff and show non-maleficence by compensating them for the
job they do. This encourages them to work with zeal. The further recommendations are to embrace
diversity, recognise excellence, and lead by example which can significantly promote staff retention in
different organisations. These recommendations are the key strategies for creating a positive yet
productive environment for driving the performance of the staff in the healthcare sector.