Delivering continuity of midwifery care to Queensland women

Establishing the context
The process of establishing the context of risk within the midwifery continuity of care model
is a part of the preliminary stage of development. The context could include which risks are
being assessed (e.g. human resource risks, risks to women using the service, risks to the
organisation). In new midwifery models of care the context of risk can also be the actual
newness of the model within the health facility (Raymond, Hartz, & Nicholl 2008).
Identifying and analysing the risk
During initial planning for the model, a process of mapping the risks in relation to care has
been suggested. It is important that risks are analysed using the Queensland Health model
of assessment provided in Appendix 3.05 and via QHEPS:
http://qheps.health.qld.gov.au/policy/docs/imp/qh-imp-070-3.pdf
This is a component of the development on any model within Queensland Health.
Evaluating the risk
Any new service model must be evaluated during and after implementation and this will
require additional support and funding. Risks identified by the previous section as being
significant will be reviewed during the implementation process.
Treating the risk
A range of specific risk management strategies will be needed within midwifery continuity of
care models. Examples of some strategies to manage risks for the women are:
• use of standardised documentation (e.g. Queensland Health Pregnancy Health Record,
clinical pathways)
• regular case reviews including normal care and care involving major clinical interventions
• notification and review of incidents using PRIME
• multidisciplinary participation in clinical audit.
Further examples minimise risks for the service:
• active multidisciplinary forums within and across the maternity unit that include consumer
representatives
• provision of adequate staffing including adequate time allowed for continuing
professional development.
This list is by no means exhaustive and further discussion around strategies is contained in
Section 11 Collaboration and also in the resources section.
Monitoring and review
Monitoring risks is an ongoing process. Currently within Queensland Health models there
is difficulty comparing and benchmarking to other services due to a lack of consistent data
collection and analysis. The establishment of a risk register which is audited on an ongoing
basis is one mechanism for review of risk at the local level.
The steering committee for the local model has an important role in clinical governance and
should receive a report at each meeting. A sample clinical governance report template is
provided in Appendix 6.01.
Existing Queensland Health processes should be used to assist with reviewing the service
such as incident and complaints system within PRIME, local or regional mortality and
morbidity reports, midwives’ outcome statistics, financial reports and attendance to KPIs
identified in the model of care document.
NMOQ has a key role in assisting districts to maintain governance for midwifery continuity of
care models. All services must have clinical governance processes. Midwifery models require
appropriate clinical governance as do all health services.
A guide to implementation
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