Organising safe and sustainable care in alongside midwifery units: Findings from an organisational ethnographic study

McCourt, Christine; Rance, Susanna; Rayment, Juliet; Sandall, Jane

doi:10.1016/j.midw.2018.06.023

Cited by 15 publications

(48 citation statements)

References 23 publications

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“…The social norms and the physical space in the FMU in this study encouraged relationship‐based care and a sense of distributed decision‐making rather than authority and top‐down hierarchy, 38‐41 which aided in the establishment of an equitable, rather than oppressive, organizational culture. Within this working environment, staff were engaged with their colleagues and the families in their care.…”

Section: Discussionmentioning

confidence: 93%

Relationships and trust: Two key pillars of a well‐functioning freestanding midwifery unit

Rocca‐Ihenacho

Yuill

McCourt

2020

Birth

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Background Despite strong evidence supporting the expansion of midwife‐led unit provision, as a result of optimal maternal and perinatal outcomes, cost‐effectiveness, and positive service user and staff experiences, scaling‐up has been slow. Systemic barriers associated with gender, professional, economic, cultural, and social factors continue to constrain the expansion of midwifery as a public health intervention globally. This article aimed to explore relationships and trust as key components of a well‐functioning freestanding midwifery unit (FMU). Method(s) A critical realist ethnographic study of an FMU located in East London, England, was conducted over a period of 15 months. Recruitment of the 82 participants was purposive. Data collection included participant observation and semi‐structured interviews, and data were analyzed thematically along with relevant local guidelines and documents. Results Twelve themes emerged. Relationships and Trust were identified as a core theme. The other 11 themes were grouped into six families, three of which: Ownership, Autonomy, and Continuous Learning; Team Spirit, Interdependency, and Power Relations; and Salutogenesis will be covered in this paper. The remaining three families: Friendly Environment; Having Time and Mindfulness; and Social Capital, will be covered in a separate paper. Conclusions A relationship‐based model of care was crucial for both the functioning of the FMU and service users’ satisfaction and may offer a compelling response to high levels of stress and burnout among midwives.

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Section: Discussionmentioning

confidence: 93%

Relationships and trust: Two key pillars of a well‐functioning freestanding midwifery unit

Rocca‐Ihenacho

Yuill

McCourt

2020

Birth

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“…Of the sixty-nine studies selected for full text screening, only twelve studies were primary research and eligible for the aims for this review. One good quality study (10/10) about AMUs in England was included twice [ 17 , 18 ] comprising a peer-reviewed journal article and a more in-depth report rich in useful data. In Table 3 , they are listed as 9A and 9B to clarify this.…”

Section: Search Resultsmentioning

confidence: 99%

What are the strategies for implementing primary care models in maternity? A systematic review on midwifery units

Batinelli

Thaels

Leister

et al. 2022

BMC Pregnancy Childbirth

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Background Midwifery Units (MUs) are associated with optimal perinatal outcomes, improved service users’ and professionals’ satisfaction as well as being the most cost-effective option. However, they still do not represent the mainstream option of maternity care in many countries. Understanding effective strategies to integrate this model of care into maternity services could support and inform the MU implementation process that many countries and regions still need to approach. Methods A systematic search and screening of qualitative and quantitative research about implementation of new MUs was conducted (Prospero protocol reference: CRD42019141443) using PRISMA guidelines. Included articles were appraised using the CASP checklist. A meta-synthesis approach to analysis was used. No exclusion criteria for time or context were applied to ensure inclusion of different implementation attempts even under different historical and social circumstances. A sensitivity analysis was conducted to reflect the major contribution of higher quality studies. Results From 1037 initial citations, twelve studies were identified for inclusion in this review after a screening process. The synthesis highlighted two broad categories: implementation readiness and strategies used. The first included aspects related to cultural, organisational and professional levels of the local context whilst the latter synthesised the main actions and key points identified in the included studies when implementing MUs. A logic model was created to synthesise and visually present the findings. Conclusions The studies selected were from a range of settings and time periods and used varying strategies. Nonetheless, consistencies were found across different implementation processes. These findings can be used in the systematic scaling up of MUs and can help in addressing barriers at system, service and individual levels. All three levels need to be addressed when implementing this model of care.

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“…Research process. Organizational ethnography is distinguished by the depth, authenticity, and richness of knowledge it assembles and generates (Bikker et al, 2017;Bruni, 2006;Conte et al, 2017;Lalleman et al, 2015;McCourt et al, 2018;McCourt et al, 2014;Small, 2009;Swinglehurst & Greenhalgh, 2015;Swinglehurst et al, 2010;Vindrola-Padros & Vindrola-Padros, 2017). Moreover, organizational ethnographic approaches allow researchers access to unbounded organizational processes (e.g., organizational learning) that display either intra-or interorganizationally beyond tangible (e.g., geographic) boundaries, which often present in health care organizations (Falzon, 2016).…”

Section: Methodological Potentialities Of Organizational Ethnographic Case Studies Applied In Health Care Researchmentioning

confidence: 99%

Organizational Ethnographic Case Studies: Toward a New Generative In-Depth Qualitative Methodology for Health Care Research?

Côté-Boileau

Gaboury

Bréton

et al. 2020

International Journal of Qualitative Methods

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A growing body of literature suggests combining organizational ethnography and case study design as a new methodology for investigating complex organizational phenomena in health care contexts. However, the arguments supporting the potential of organizational ethnographic case studies to improve the process and increase the impact of qualitative research in health care is currently underdeveloped. In this article, we aim to explore the methodological potentialities and limitations of combining organizational ethnography and case study to conduct in-depth empirical health care research. We conducted a scoping review, systematically investigating seven bibliographic databases to search, screen, and select empirical articles that employed organizational ethnographic case study to explore organizational phenomena in health care contexts. We screened 573 papers, then completed full-text review of 74 papers identified as relevant based on title and abstract. A total of 18 papers were retained for analysis. Data were extracted and synthesized using a two-phase descriptive and inductive thematic analysis. We then developed a methodological matrix that positions how the impact, contextualization, credibility, and depth of this combined methodology interact to increase the generative power of in-depth qualitative empirical research in health care. Our review reveals that organizational ethnographic case studies have their own distinct methodological identity in the wider domain of qualitative health care research. We argue that by accelerating the research process, enabling various sources of reflexivity, and spreading the depth and contextualization possibilities of empirical investigation of complex organizational phenomena, this combined methodology may stimulate greater academic dynamism and increase the impact of research. Organizational ethnographic case studies appear as a new in-depth qualitative methodology that both challenges and improves the conventional ways we study the lives of organizations and the experiences of actors within the interconnected realms of health care.

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Organising safe and sustainable care in alongside midwifery units: Findings from an organisational ethnographic study

Cited by 15 publications

References 23 publications

Relationships and trust: Two key pillars of a well‐functioning freestanding midwifery unit

Relationships and trust: Two key pillars of a well‐functioning freestanding midwifery unit

What are the strategies for implementing primary care models in maternity? A systematic review on midwifery units

Organizational Ethnographic Case Studies: Toward a New Generative In-Depth Qualitative Methodology for Health Care Research?

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