Delivering continuity of midwifery care to Queensland women

Section 12
Sustaining and evaluating
Models need to be developed in such a way that they are
able to be sustained. Strategies to enable long term viability
will be discussed throughout this section. Strategies to build
sustainability into the initial planning of the model are covered in
Section 3.
Ongoing communication within the model
Communication within the model is the basis for successful implementation. It has been
stated previously that in cases of poor outcomes, the great majority are found to have
problems in communication as a root cause, while only a small minority result from
inadequate skills.
Establishing effective communication within the organisation is an essential first step to
developing a model. The plan needs to include the steps that all stakeholders will take when
communicating with each other.
Effective communication is:
• open and honest
• inclusive
• timely
• ongoing (J. Toohill, personal communication, February 14, 2011).
These factors provide impetus for building relationships and establishing trust and respect.
Issues for managers
The foundation of the model needs to include a shared understanding about meeting the
needs of the woman and the midwife. Managers need a clear understanding that their role is
to actively enable midwives to determine the way in which they work. Managers often report
that midwives indicate they ‘don’t want to’ or ‘can’t’ work in continuity of care models. It is
important that the midwives understand the model well and that they have the support of a
manager who provides the flexibility that is required for midwives to adapt to the model and
respond to clinical responsibilities. Issues for managers include:
• recruitment of committed midwives who will receive unquestionable management
support. The midwives will need to have a balanced perspective of work-life balance, be
comfortable to seek support of their manager and have or be prepared to develop clinical
skills to provide care across the continuum in line with the model of care provided
• ability to trust the midwives to manage and make appropriate decisions about their practice.
• an expectation that midwives will attend the majority of the births for their own caseload
women, but have the opportunity to have care provided by known back up midwives
• appropriate consultation about model-specific issues (demography of clients and
geographic area to cover, determining numbers of women in each midwife’s caseload)
• support for midwives when the woman makes an informed decision that conflicts with
unit policy or consultation and referral guidelines (Homer, et al. 2008)
• support and integration with core staff where these are in place
• midwifery models are challenging for managers who are used to close on-site contact with
their staff, managing rostered shifts and counting hours. Continuity of care models are
not driven by the needs of the service but by the needs of women and therefore may be
perceived as more difficult to ‘manage’. They are not difficult but do require flexibility in
management, flexibility with staffing arrangements and flexibility in how care is delivered.
A guide to implementation
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