Delivering continuity of midwifery care to Queensland women

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• The project officer develops sessions to inform all staff about the model in conjunction with the education unit. Special attention should be given to autonomy of the practitioners as well as the difference between shift work and ‘no fixed hours’ (annualised salary arrangements). • The senior executive sponsor will seek participation from interested midwives within the facility. • Opportunities to announce plans in the media can be considered by the project officer and executive staff (e.g. community forums or media events). • With support from the CEO and senior executive, the project officer establishes the steering committee to guide implementation and ongoing monitoring for the new model. See sample terms of reference in Appendix 3.02. This should include (but is not limited to) internal and external stakeholders: – Aboriginal health worker/ clinician / consumer (all if possible) – Allied health staff – Australian College of Midwives (ACM) – Child health staff – Maternity-specific consumer representatives – District management – Executive sponsor – Finance officer – General Practitioner/s – Midwives interested in working on the new model – Queensland Nurses Union (QNU) (note: a letter of invitation should be sent to QNU State Secretary, so that appropriate representation can be provided and supported) – Senior midwifery and medical staff – University midwifery academic representation. • The role of the steering committee should include: – agreeing to the philosophy and vision of the model – setting the strategic direction for the service – reviewing work on the project—business case, model of care, mapping pathways – overseeing ongoing development of the model over time – overseeing clinical guideline development – involvement of consumers in a meaningful way throughout – nomination of key members to formulate and develop a local agreement relating to the terms and conditions of the midwives (if different from current arrangements) – setting, reviewing and monitoring clinical Key Performance Indicators (KPIs) with reference to statewide requirements – monitoring of activity, finance, human resources issues and outcomes – monitoring quality and safety including clinical risk review, complaints, consumer feedback, workplace health and safety and audit. • The demographic factors within the geographic/catchment area can be mapped, either in a working group or by the project officer, to assess past trends and future demand for maternity services. Identify where the current primary, secondary and tertiary services are provided. Assess current key outcomes which may align with the outcomes you would expect within midwifery model of care (e.g. normal birth rates and breastfeeding rates). Refer Homer et al. (2008, pp. 47-65). • A community forum or consumer working group will assist the project officer to assess the specific maternity care needs and preferences of local women and families. This forum does not need to address whether consumers want a midwifery model. Focus on women who currently use local maternity services the least (e.g. women who travel elsewhere for care, women who attend fewest appointments). 22 Delivering continuity of midwifery care to Queensland women
• Develop a philosophy for the model. A stakeholder forum is a good place for this. A sample philosophy and notes from the associated workshop are provided in Appendix 3.04 of this guide. • The project officer will develop a model of care document including pathways for care. This is informed by the steps above, including mapping, consultation and philosophy. • The project officer will develop a business plan for implementation of the model (see Queensland Health template, Appendix 3.06), consider ongoing office space, administrative support and data collection. • Develop a risk register based on AS/NZS Risk Management Standards 4360:2004 and the companion guide (Standards Australia and Standards New Zealand, 2004) (refer below; Queensland Health Risk Matrix in Appendix 3.05 and Homer, Brodie & Leap (2008, p. 132)). Communicate and consult Establish the context – Objectives – Stakeholders – Criteria – Define key elements Identify the risks – What can happen – How can it happen Analyse the risks – Review controls – Likelihoods Evaluate the risks – Evaluate risks – Rank risks Treat the risks – Identify options – Select best responses – Develop risk treatment plans – Implement Monitor and review Phase 3—Pre–implementation • After development and approval of the business case, develop a staged implementation plan. • Senior executive sponsor advises local staff of approval. • Project officer organises and convenes team-building activity for multidisciplinary team, regardless of existing culture. • The project officer and senior staff develop service agreements with non-government providers of maternity/child health care to facilitate models of care appropriate to the community. Establish service agreements with partners such as Child Health and community services including consideration of shared clinical space. • Secure access and transfer arrangements such as emergency transport services. Ensure service agreements are in place with other services where transfers are anticipated. • The continued involvement of the QNU is required to develop an industrial agreement for wages and conditions. • The local industrial agreement will include case load numbers per FTE midwife. This is a maximum of 40 women per FTE per year and is reduced according to complexity of care and other demands on midwives. This is discussed in Section 8. A sample local agreement template is provided in Appendix 8.02. • Develop midwifery roles and position descriptions: – in some facilities (e.g. urban) a minimum skill set may be set and midwives recruited accordingly – in some areas (particularly rural) existing midwives may be recruited and may require support to upskill to required level for continuity practice. • Develop orientation plan for midwives, including: – responsibilities and expectations in role – travel arrangements and reimbursements A guide to implementation 23
Page 1 and 2: Nursing and Midwifery Office, Queen
Page 3: Nursing and Midwifery Office, Queen
Page 6 and 7: Section 9 Professional development
Page 8 and 9: 4 Delivering continuity of midwifer
Page 10 and 11: 5. Cultural change—building a sup
Page 12 and 13: Section 1 Why provide continuity of
Page 14 and 15: These reforms can be seen as part o
Page 16 and 17: The emotional and social benefits w
Page 18 and 19: Section 2 Midwifery continuity mode
Page 20 and 21: shifts, but also rotate across ante
Page 22 and 23: For well women, evidence supports t
Page 24 and 25: Gottvall, K., Waldenstrom, U., Ting
Page 28 and 29: - on-call arrangements - relief - (
Page 30 and 31: Section 4 Key elements to successfu
Page 32 and 33: Key issues for leaders in midwifery
Page 34 and 35: At the Gold Coast Hospital Birth Ce
Page 36 and 37: Goondiwindi A review of Goondiwindi
Page 38 and 39: Culture of birth—current issues I
Page 40 and 41: A mechanism to inform and engage th
Page 42 and 43: Section 6 Clinical governance Eleme
Page 44 and 45: Consumer participation and informed
Page 46 and 47: Clinical practice guidelines To ens
Page 48 and 49: Award levels for midwives Often mid
Page 50 and 51: Balance of service demand and resou
Page 52 and 53: Considerations when implementing ca
Page 54 and 55: Section 8 Industrial issues The ann
Page 56 and 57: Example: A new MGP model is impleme
Page 58 and 59: References Collins, C., Fereday, J.
Page 60 and 61: Each midwife working in Queensland
Page 62 and 63: Midwives working in continuity of c
Page 64 and 65: Skills for managers Managers suppor
Page 66 and 67: • Midwifery Practice Review (MPR)
Page 68 and 69: • Find a few sources of evidence
Page 70 and 71: Interactions within the whole MGP T
Page 72 and 73: Measurement of continuity provided
Page 74 and 75: • clearly outline what constitute
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At 1 pm I receive a call from K, sh
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Section 11 Collaborative maternity
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Example Mary presents to Miles Hosp
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Collaboration with GPs A range of m
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How to sustain your model The abili
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References Homer, C. Brodie, P. & L
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MBS rebates are available for a ran
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Hybrid private and public models Wo
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operationalised the universal postn
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Glossary This glossary includes all
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Team midwifery: A model of maternit
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94 Department of Health and Ageing.
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Queensland Health. (2008b). Queensl
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Acknowledgments Queensland Health w
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