Collaborative working within community maternity services – is this the chink in the armour?

Abstract

Contemporary maternity care in Northern Ireland will be driven by the aims of Midwifery 2020 ( Department of Health (DH), 2010 ), High Quality Woman’ s Health Care ( Royal College of Obstetricians and Gynaecologists (RCOG), 2011 ), Maternity Strategy for Northern Ireland2012–2018 ( Department of Health, Social Services and Public Safety (DHSSPSNI), 2011 ) and Transforming Your Care ( DHSSPSNI, 2011 ). These reports all have at their core the idea of’ promoting normality’ within a maternity service that will be community based and led by midwives. With this shift, general practitioners (GPs) will be expected to play a significant role within the teams that care for pregnant women. Effective collaboration between professional groups is an essential element in good quality and safe care. It is necessary if the planned transfer of services is to succeed. This study explores if midwives, GPs and those planning maternity services believed that systems were in place for effective collaborative working in the community. The service evaluation used mixed methods to collect data, including five in-depth interviews, questionnaires and a professional forum, with the results demonstrating that few community practices have implemented systems for sharing information between community midwives and GPs. The study found that collaborative working is not a characteristic within community maternity services. It revealed four recurrent themes that hinder effective collaboration: organisation, inter-professional relationships, communication, and quality and safety.

Interprofessional cooperation by midwives in the field of out-of-hospital obstetrical care: an integrative review / Interprofessionelle Kooperation von Hebammen im Handlungsfeld der ambulanten geburtshilflichen Versorgung: ein integratives Review

“…Apart from this, the health care services of both countries monitor the children from birth on up to toddler age; in Australia, this is carried out by child and family health nurses, in Sweden by child health care nurses (Barimani & Hylander, 2008;Homer et al, 2009). In six other studies, the primary interest lies in interprofessional cooperation between midwives and physicians (Ratti et al, 2014;Schölmerich et al, 2014;Shaw, 2013;Skinner & Foureur, 2010;Smith et al, 2009;Vedam et al, 2012). Three studies examine the introduction of child or family health promotion programmes involving various groups of professions (Edvardsson et al, 2011;Edvardsson et al, 2012;Schmied et al, 2015), while four studies focus on the cooperation between professions in the health and social service sectors (Ayerle et al, 2014;Clancy, Gressnes, & Svensson, 2013;Miers & Pollard, 2009;While, Murgatroyd, Ullman, & Forbes, 2006).…”

“…A number of studies broach the issue of communication problems between the groups of professions and their effect on collaboration (Barimani & Hylander, 2008;Homer et al, 2009;Nagel-Brotzler et al, 2005;Schölmerich et al, 2014;Schmied et al, 2015;Shaw, 2013;Smith et al, 2009). Poor communication jeopardises the efficacy of working relationships (Murray-Davis et al, 2011;Psaila et al, 2015) and is identified as a 'key barrier' (Shaw, 2013), 'key problem' or as 'an elephant in the room' .…”

“…Poor communication jeopardises the efficacy of working relationships (Murray-Davis et al, 2011;Psaila et al, 2015) and is identified as a 'key barrier' (Shaw, 2013), 'key problem' or as 'an elephant in the room' . Midwives experience this lack of communication more often as an impediment for collaboration in the context of maternity care than obstetricians or family physicians do (Smith et al, 2009).…”

“…Midwives experience this lack of communication more often as an impediment for collaboration in the context of maternity care than obstetricians or family physicians do (Smith et al, 2009). Three studies present an overview of the communication difficulties between midwives and physicians (Nagel-Brotzler et al, 2005;Schölmerich et al, 2014;Shaw, 2013), showing that pregnant women may take on an active, communicative-supportive role by transferring information between the professional groups (Schölmerich et al, 2014).…”

“…In contrast, a 'link perspective', in which one's own abilities are prioritised and tasks are not seen as part of a comprehensive care provision system, has a restraining influence on the cooperation (Barimani & Hylander, 2008;Barimani & Hylander, 2012). Some studies address topics of cooperation from different perspectives of the professional groups (Barimani & Hylander, 2008;Barimani & Hylander, 2012;Munro et al, 2013;Murray-Davis et al, 2011;, others focus explicitly on the differing perspectives between midwives and physicians (Ratti et al, 2014;Schölmerich et al, 2014;Shaw, 2013;Smith et al, 2009;Vedam et al, 2012), which result in tension and conflict, mistrust, and a lack of respect (Ratti et al, 2014). Whereas 60.7% of the midwives who took part in a quantitative survey described different perspectives as being a central impediment for interprofessional cooperation with physicians, only 46.5% of the obstetricians and 23.3% of the family physicians asked were of the same opinion (Smith et al, 2009).…”