Delivering continuity of midwifery care to Queensland women

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Key issues for leaders in midwifery models: • Leaders need to understand woman-centred care and informed choice. They must understand the philosophy for the model is the rudder that keeps it on course. • Leaders accept, support and articulate to others that primary care midwives are essentially self-managing and require support and access to ongoing professional growth and development opportunities. • Leaders will inspire and ensure development of policy and processes that support the autonomy of midwives as highly skilled professionals. • Leaders must clarify and model respectful communication and collaborative interdisciplinary relationships as is expected in the provision of contemporary womancentred care. • Leaders guide and monitor development of and agreement to, robust maternity clinical governance providing for safety and sustainability. There is a need for patience and persistence to develop interdisciplinary relationships which have a basis of respect and collegiality. This leads to trust in the midwives as primary caregivers. Organisations that espouse trust in midwives as primary caregivers are most likely to succeed in implementing midwifery continuity of care models. A key requirement for leaders in midwifery continuity of care models is that they not only understand the value of midwifery continuity of care but also embrace the model. The commitment and drive required to transform traditional models to midwifery continuity of care requires leaders to research and understand the importance of continuity of care for women. Key attributes of midwifery leaders: • open to learn • flexible • self-informed and share knowledge easily • persistent • inclusive • focused • listen and are responsive • maintain commitment and dedication • have the ability to lead and influence others (J. Toohill, personal communication, February 14, 2011). Communication Planning for the model within your service Establishing effective communication within services can be challenging under the best of circumstances. A communication plan ensuring all stakeholders within the service are, and remain, aware and updated on the development of the new model is one element of successful implementation of the model. Homer, Brodie and Leap (2008) describe commencing a new continuity midwifery model at St George Hospital in Sydney during the 1990’s. The project was given impetus by an external regional review that recommended reform of maternity services. Change was driven by a motivated and committed small multidisciplinary group (midwives, obstetricians, researchers) built on trust. They advised that establishing effective communication and collaborative processes evolved over time and were ongoing; likening the process to ingredients for a successful marriage—it takes time, requires work and attention, predicated on commitment and needs mutual understanding and respect (Brodie, Davis, & Homer 2008). 28 Delivering continuity of midwifery care to Queensland women
Paramount to the success of the model is development of values and vision that is shared within the entire maternity unit. A short, clear mission statement ensures a consistent message is provided for communication both within the unit and to external stakeholders. Successful communication involves: • identifying key multidisciplinary leaders who can influence change within the service • open dialogue within the service is required to identify the level of support for midwifery continuity of care models • demonstrating a positive commitment to inclusion, shared decision making and problem solving and identifying barriers. Securing a senior level sponsor for the development of the model is important and provides a shared responsibility for success. It is strategically effective to have communication and discussion within the organisation led by a person in a position of influence who can provide guidance in relation to strategies and available resources and who can keep the model on the agenda at Hospital and Health Service (HHS) and state-wide meetings. Effective communication relies on ensuring everyone has: • been identified for inclusion in the steering committee for the model (see Engaging Stakeholders below) • access to information: proposal shared, minutes of meetings are available and displayed, information sessions provided, newsletters distributed • opportunities to contribute: genuine representation within planning or management groups • processes for clarification: consultation has occurred at a number of levels and times (J. Toohill personal communication, February 14, 2011). Expectations Based on the philosophy and model developed, staff working in these models will need to have a clear picture of what they can expect. • What is the arrangement for handing over care, by what means and with whom • When and where are clinical outcomes recorded and audited • Who and how can collaborating staff be contacted regarding variations in a woman’s health • How will staff respond when women choose to take a different path to that which is recommended Communication of these expectations leaves staff with clarity about their roles. It is important to document role delineation so that if situations arise where staff members act outside of the parameters expected of them, there are opportunities for early resolution of difficulties. Bumps and blocks The entire team needs to be involved in planning communication processes. In one MGP model obstetricians were unable to attend regular collaborative clinical meetings with the midwives because the administration team had changed the obstetric rosters. Despite seeking rectification of this, senior administrators seemed not to comprehend the importance of these meetings to the sustainability of the model by maintaining collegial interdisciplinary relationships and maintaining clinical safety. This resulted in internal conflict and major difficulties for the service. Significant discussion and an entirely new way of approaching collaborative meetings (new time, new people involved, quicker processes) was required to resolve the situation. A range of communication strategies are outlined in Section 10 and Section 11. A guide to implementation 29
Page 1 and 2: Nursing and Midwifery Office, Queen
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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 26 and 27: • The project officer develops se
Page 28 and 29: - on-call arrangements - relief - (
Page 30 and 31: Section 4 Key elements to successfu
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
Page 76 and 77: At 1 pm I receive a call from K, sh
Page 78 and 79: Section 11 Collaborative maternity
Page 80 and 81: 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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Delivering continuity of midwifery care to Queensland women

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