Restoring Thinking and Collaboration in a Maternity Service Under Pressure

Situation

An NHS Trust approached the Director of Tavistock Consulting in relation to its maternity services following a sustained rise in critical incidents and tragic deaths. While an external review identified a series of technical and procedural gaps, it also revealed significant relational strain. Communication between professional groups had deteriorated, silos had hardened, and the atmosphere was charged with defensiveness, blame and fear.

When we entered the service, staff were angry, exhausted and turning against one another. Groups had split into “us and them,” with blame circulating across the ward and across professional groups. Leaders—bearing the weight of responsibility—were struggling to work together cohesively. From a systems-psychodynamic perspective, we saw a traumatised team of committed staff operating under intense anxiety, mobilising defences such as splitting, projection and fight/flight to try and protect themselves against the emotional pain of loss, error and scrutiny (Bion, 1961; Menzies-Lyth, 1960). Rather than the defences protecting them, they were leading to repetition of the tragic incidents they had already experienced.

Our approach

Over a year, we carried out a whole-system intervention blending individual and collective work to restore leadership containment, reflective capacity and collaboration.

1. Individual Coaching for the Leadership Team

Each leader received one-to-one coaching to explore the emotional pressures of the work, to understand and support them with their individual pressures, and develop a steadier, more reflective leadership stance.

2. Team Coaching for the Leadership Team
Joint sessions enabled the three leaders to work together as a coherent leadership container. Through strengthening relationships, clarifying roles and aligning around the primary task, they became more able to hold the system and model thoughtful, connected leadership (Obholzer & Roberts, 1994).

3. Group Consultancy with the Wider Staff Team
We facilitated reflective spaces and cross-disciplinary group consultations. These meetings encouraged staff to speak openly about the mistakes that had been made, the guilt, shame and guilt they experienced alongside the everyday challenges of the work they do. They learnt to recognise the defensive patterns shaping their behaviour and see these as symptoms to watch for and support each other in future. They recovered their ability gradually to think together about complexity, risk and responsibility.

What changed

As we withstood their initial aggression and hostility without retaliation and with empathy and understanding, they began to see we were not there to judge or reprimand but to support and help them recover. By holding a safe space for them to begin to share their experiences and the trust developed between them, the emotional temperature lowered, and staff began to reconnect across professional boundaries. In time, the leadership team developed a unified presence that steadied the system and role modelled interdisciplinary collaboration once again. Staff became more able to face painful realities directly rather and support each other to process the feelings rather than displacing them into conflict or withdrawal.

This marked a shift from blame to learning. Collaboration improved, morale lifted, and a sense of shared purpose re-emerged.

Impact

By the end of the intervention:

• Critical incidents reduced, communications improved, and a more reflective and collaborative thinking approach was taken to risk.

• Staff sickness and turnover decreased, reflecting a safer and more supportive culture leading to increased morale

• The leadership team became a model of effective leadership, demonstrating stability, alignment and relational capacity under pressure.

• The ward became an example of hope and good practice within the wider Trust and was subsequently put forward for awards.

• Practices introduced during the consultancy were sustained, with ongoing reflective spaces, cross-disciplinary dialogue and strengthened leadership habits continuing well beyond our involvement.

Conclusion

This case illustrates how systems-psychodynamic consultancy can transform a service under pressure by working directly with the emotional and unconscious forces shaping behaviour. By supporting leaders and clinicians to think, reflect and connect—even in the face of loss and uncertainty—the ward not only stabilised but became a beacon of good practice for the wider organisation.

Please note: This is an anonymised and amalgamated case study