Jo Longman1, Jude Kornelsen2, Jen Pilcher3, Sue Kildea4, Sue Kruske5, Stefan Grzybowski6, Sarah Robin7, Margaret Rolfe8, Deborah Donoghue9, Geoffrey G Morgan10, Lesley Barclay11. 1. University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Electronic address: jo.longman@ucrh.edu.au. 2. Centre for Rural Health Research, University of British Columbia, 5950 University Boulevard, Vancouver, British Columbia, V6T 1Z3, Canada. Electronic address: jude.kornelsen@familymed.ubc.ca. 3. University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Electronic address: jpil2286@uni.sydney.edu.au. 4. School of Nursing, Midwifery and Social Work, The University of Queensland, Level 3 Chamberlain Building, St Lucia QLD 4072, Australia; Mothers, Babies and Women's Health, Mater Health and Mater Research Institute, UQ, Level 1 Aubigny Place, Raymond Terrace, South Brisbane, QLD 4101, Australia. Electronic address: sue.kildea@mater.uq.edu.au. 5. School of Nursing, Midwifery and Social Work, The University of Queensland, Level 3 Chamberlain Building, St Lucia QLD 4072, Australia; Institute for Urban Indigenous Health, Bowen Hills, QLD 4006, Australia. Electronic address: sue.kruske@iuih.org.au. 6. Centre for Rural Health Research, University of British Columbia, 5950 University Boulevard, Vancouver, British Columbia, V6T 1Z3, Canada. Electronic address: sgrzybow@mail.ubc.ca. 7. University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Electronic address: sarah.robin@ucrh.edu.au. 8. University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Electronic address: margaret.rolfe@ucrh.edu.au. 9. University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia; Gnibi College of Indigenous Australian Peoples, Southern Cross University, Australia. Electronic address: deborah.donoghue@scu.edu.au. 10. University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Electronic address: geoffrey.morgan@sydney.edu.au. 11. University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Electronic address: lesley.barclay@sydney.edu.au.
Abstract
INTRODUCTION: In Australia, many small birthing units have closed in recent years, correlating with adverse outcomes including a rise in the number of babies born before arrival to hospital. Concurrently, a raft of national policy and planning documents promote continued provision of rural and remote maternity services, articulating a strategic intent for services to provide responsive, woman-centred care as close as possible to a woman's home. The aims of this paper are to contribute to an explanation of why this strategic intent is not realised, and to investigate the utility of an evidence based planning tool (the Toolkit) to assist with planning services to realise this intent. METHODS: Interviews, focus groups and a group information session were conducted involving 141 participants in four Australian jurisdictions. Field notes and reports were thematically analysed. RESULTS: We identified barriers that helped explain the gap between strategic intent and services on the ground. These were absence of informed leadership; lack of knowledge of contemporary models of care and inadequate clinical governance; poor workforce planning and use of resources; fallacious perceptions of risk; and a dearth of community consultation. In this context, the implementation of policy is problematic without tools or guidance. CONCLUSIONS: Barriers to operationalising strategic intent in planning maternity services may be alleviated by using evidence based planning tools such as the Toolkit.
INTRODUCTION: In Australia, many small birthing units have closed in recent years, correlating with adverse outcomes including a rise in the number of babies born before arrival to hospital. Concurrently, a raft of national policy and planning documents promote continued provision of rural and remote maternity services, articulating a strategic intent for services to provide responsive, woman-centred care as close as possible to a woman's home. The aims of this paper are to contribute to an explanation of why this strategic intent is not realised, and to investigate the utility of an evidence based planning tool (the Toolkit) to assist with planning services to realise this intent. METHODS: Interviews, focus groups and a group information session were conducted involving 141 participants in four Australian jurisdictions. Field notes and reports were thematically analysed. RESULTS: We identified barriers that helped explain the gap between strategic intent and services on the ground. These were absence of informed leadership; lack of knowledge of contemporary models of care and inadequate clinical governance; poor workforce planning and use of resources; fallacious perceptions of risk; and a dearth of community consultation. In this context, the implementation of policy is problematic without tools or guidance. CONCLUSIONS: Barriers to operationalising strategic intent in planning maternity services may be alleviated by using evidence based planning tools such as the Toolkit.
Authors: Helen L McLachlan; Michelle Newton; Fiona E McLardie-Hore; Pamela McCalman; Marika Jackomos; Gina Bundle; Sue Kildea; Catherine Chamberlain; Jennifer Browne; Jenny Ryan; Jane Freemantle; Touran Shafiei; Susan E Jacobs; Jeremy Oats; Ngaree Blow; Karyn Ferguson; Lisa Gold; Jacqueline Watkins; Maree Dell; Kim Read; Rebecca Hyde; Robyn Matthews; Della A Forster Journal: EClinicalMedicine Date: 2022-05-04