title: Working relationships between obstetric care staff and their managers: a critical incident analysis.
abstract: Malawi continues to experience critical shortages of key health technical cadres that can adequately respond to Malawi's disease burden. Difficult working conditions contribute to low morale and frustration among health care workers. We aimed to understand how obstetric care staff perceive their working relationships with managers.
  
  
  
  A qualitative exploratory study was conducted in health facilities in Malawi between October and December 2008. Critical Incident Analysis interviews were done in government district hospitals, faith-based health facilities, and a sample of health centres' providing emergency obstetric care. A total of 84 service providers were interviewed. Data were analyzed using NVivo 8 software.
  
  
  
  Poor leadership styles affected working relationships between obstetric care staff and their managers. Main concerns were managers' lack of support for staff welfare and staff performance, lack of mentorship for new staff and junior colleagues, as well as inadequate supportive supervision. All this led to frustrations, diminished motivation, lack of interest in their job and withdrawal from work, including staff seriously considering leaving their post.
  
  
  
  Positive working relationships between obstetric care staff and their managers are essential for promoting staff motivation and positive work performance. However, this study revealed that staff were demotivated and undermined by transactional leadership styles and behavior, evidenced by management by exception and lack of feedback or recognition. A shift to transformational leadership in nurse-manager relationships is essential to establish good working relationships with staff. Improved providers' job satisfaction and staff retentionare crucial to the provision of high quality care and will also ensure efficiency in health care delivery in Malawi.
authors: College of Medicine-Centre for Reproductive Health, Private bag 360, Blantyre 3, Malawi. echipeta@medcol.mw.
authors: Effie
authors: 0000-0002-7925-3443
authors: E
authors: Chipeta
authors: Centre for Maternal and Child Health Research, School of Health Sciences, City University London, 1 Myddelton Street, London, EC1R 1UW, UK.
authors: Susan
authors: S
authors: Bradley
authors: College of Medicine-Centre for Reproductive Health, Private bag 360, Blantyre 3, Malawi.
authors: Wanangwa
authors: W
authors: Chimwaza-Manda
authors: School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Ireland.
authors: Eilish
authors: E
authors: McAuliffe
mesh_terms: D000328:Adult; D005260:Female; D006282:Health Personnel; D006740:Hospital Administrators; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D007588:Job Satisfaction; D007857:Leadership; D008295:Malawi; D008297:Male; D009042:Motivation; D009775:Obstetrics and Gynecology Department, Hospital; D036301:Qualitative Research; D011787:Quality of Health Care
keywords: Job satisfaction; Leadership; Staff motivation; Work performance; Working relationships