Delivering continuity of midwifery care to Queensland women

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Clinical practice guidelines To ensure consistency of women’s clinical care, evidenced-based clinical guidelines should be the same across services. Queensland Health has a program to develop statewide clinical guidelines, led by the Queensland Maternity and Neonatal Clinical Guidelines Steering Committee. Guidelines are available to download from: www.health.qld.gov.au/cpic/ resources/mat_guidelines.asp Midwives should be familiar with relevant clinical guidelines. If local guidelines are required due to unavailability of state or national guidelines, development processes should be multidisciplinary, include continuity of care midwives and consumers and have a process for regular review and be updated as new evidence becomes available. References Cochrane, A.L. (1979). 1931-1971: a critical review, with particular reference to the medical profession. In: Medicines for the year 2000. London: Office of Health Economics:1-11. Department of Health. (1998). A First Class Service: Quality in the New NHS. www.dh.gov.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_4006902 Forster, P. (2005). Queensland Health Systems Review. Final Report. www.health.qld.gov.au/health_sys_review/final/qhsr_final_report.pdf Freeman, L., Adair, V., Timperley, H. & West, S. (2006). The influence of the birthplace and models of care on midwifery practice for the management of women in labour. Women and Birth. 19(4), 97-105. Homer, C., Brodie, P. & Leap N. (2008). Midwifery Continuity of Care. Sydney: Elsevier. National Collaborating Centre for Women’s and Children’s Health. (2007). Intrapartum Care: care of healthy women and their babies during childbirth. RCOG Press. www.nice.org.uk/nicemedia/live/11837/36275/36275.pdf National Health and Medical Research Council. (NHMRC). (2010). National Guidance on Collaborative Maternity Care. NHMRC, Canberra. Accessed 27 July 2011 www.nhmrc.gov.au/guidelines/publications/cp124 Queensland Government. (2008). Midwifery Models of Care: implementation guide. Queensland Government, Brisbane. www.health.qld.gov.au/qhpolicy/docs/gdl/qhgdl-906.pdf Queensland Health. (2007). Clinical Governance Policy - Policy for all components of Queensland Health. www.health.qld.gov.au/qhpolicy/docs/pol/qh-pol-007.pdf Queensland Health. (2008b). Queensland Health Integrated Risk Management Policy. (Policy Identifier 13355). Available via QHEPS. Queensland Health. (2008c). Queensland Health Clinical Audit. http://qheps.health.qld.gov.au/policy/docs/imp/qh-imp-007-5.pdf Raymond, J., Hartz, D. & Nicholl, M. (2008). Ensuring safety and quality. In C. Homer, P. Brodie & N. Leap (Eds). Midwifery Continuity of Care. Sydney: Elsevier. Scally, G. & Donaldson, L.J. (1998). Clinical governance and the drive for quality improvement in the new NHS in England. BMJ. 317 (7150), 61-65. www.bmj.com/content/317/7150/61.full Standards Australia and Standards New Zealand. (2004). AS/NZS 4360:2004, Risk Management. Sydney, N.S.W. ISBN 0 7337 5904 1. Starey, N. (2001). What is clinical governance Hayward Medical Publications. 1(12), 1-7. www.medicine.ox.ac.uk/bandolier/painres/download/whatis/WhatisClinGov.pdf 42 Delivering continuity of midwifery care to Queensland women
Section 7 Costing and revenue for caseload models Evidence demonstrates caseload models of care cost less than traditional models of maternity care. This is due to: • flexible care delivery which is responsive to demand • increase in spontaneous labour rates with decreases in obstetric interventions and associated reductions in costs • decreased length of stay so decreased demand on bed occupancy • decreased readmission rates • increased staff satisfaction in caseload with improved retention of workforce (Collins, et al. 2010; McCourt & Page 1996; Sandall 1997; Sandall 1998). Midwives working for Queensland Health in a caseload model will be paid an annualised salary in recognition of flexible patterns of work to provide continuity of care. The annualised salary is the ordinary rate of pay and an all purpose loading (of 35 per cent at time of publication), which is in compensation for ordinary hours worked and in consideration of all other penalty rates and allowances the midwife would have been entitled to under the Award if not working within the caseload arrangement. No backfilling is required in normal circumstances (e.g. annual leave). Section 8 of this guide provides information about industrial issues and awards in continuity of care models. Establishment costs Many of the current midwifery models have been established by realigning resources and reconfiguring work patterns from traditional models with little or no additional cost (for detailed examples see the Goondiwindi Midwifery Group Practice First 12 Month Review available from the NMOQ website; and chapter six of Midwifery Continuity of Care by Homer, et al. 2008). Other models have invested additional resources to set up continuity models to serve expanding birth numbers. Some areas have channelled funding for the universal postnatal contact service to continuity models rather than add an additional component to the traditional fragmented service. Staff costs can be re-oriented without additional costs to the District over current service provisions. In 2006 the Mater Mothers’ Hospital introduced an MGP for young mothers in an all risk model based on a caseload of 35 women annually per midwife. Savings of $577 were identified for each woman accessing this care, and used to offset costs for equipment (K. Wilson, personal communication, March 23, 2011). Local overhead costs should be reviewed as these vary between services and have been reported to sometimes be overinflated. Where birth centres exist, this space should be reviewed in line with Queensland Health Service Planning Benchmarks (Queensland Health 2010b)and ensure capacity is maintained at 160 births per birth centre room per annum to optimise cost savings. Input costs The input costs listed below (Table 1) for setting up an MGP are based on six FTE midwives providing care to 240 women per year (note that this is the maximum caseload). The definitions and detail of caseload and MGP are discussed in Section 2 and the glossary of this document. A guide to implementation 43
Page 1 and 2: Nursing and Midwifery Office, Queen
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Page 6 and 7: Section 9 Professional development
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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
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Page 28 and 29: - on-call arrangements - relief - (
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Page 32 and 33: Key issues for leaders in midwifery
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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 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
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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
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Page 72 and 73: Measurement of continuity provided
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Page 78 and 79: Section 11 Collaborative maternity
Page 80 and 81: Example Mary presents to Miles Hosp
Page 82 and 83: Collaboration with GPs A range of m
Page 84 and 85: How to sustain your model The abili
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Page 94 and 95: 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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