Lessons learned from the implementation of Canada's first alongside midwifery unit: A qualitative explanatory study

Darling, Elizabeth; Easterbrook, Riley; Grenier, Lindsay N.; Malott, Anne; Murray‐Davis, Beth; Mattison, Cristina A.

doi:10.1016/j.midw.2021.103146

Cited by 7 publications

(4 citation statements)

References 7 publications

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“…We found that hospital intrapartum care funding arrangements in Ontario, which are driven by both volume and acuity, may either encourage or discourage midwifery integration depending on contextual factors. In settings where there is opportunity to increase the volume of births at a hospital, the integration of midwives may be viewed as a benefit to a hospital because midwives provide intrapartum care that would otherwise be provided by nurses paid by the hospital and midwife-attended births have shorter lengths of stay on average and therefore lower direct costs to the hospital [ 40 ]. In other hospitals, intrapartum care is not viewed as a significant source of income for the hospital and therefore is not a priority, making changes to the status quo and the integration of midwives more difficult.…”

Section: Resultsmentioning

confidence: 99%

The impact of funding models on the integration of Ontario midwives: a qualitative study

Darling,

Lemay,

Ejiwunmi

et al. 2023

BMC Health Serv Res

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Background Nearly 30 years post legalisation and introduction, midwifery is still not optimally integrated within the health system of Canada’s largest province, Ontario. Funding models have been identified as one of the main barriers. Methods Using a constructivist perspective, we conducted a qualitative descriptive study to examine how antepartum, intrapartum, and postpartum funding arrangements in Ontario impact midwifery integration. We conceptualized optimal ‘integration’ as circumstances in which midwives’ knowledge, skills, and model of care are broadly respected and fully utilized, interprofessional collaboration and referral support the best possible care for patients, and midwives feel a sense of belonging within hospitals and the greater health system. We collected data through semi-structured telephone interviews with midwives, obstetricians, family physicians, and nurses. The data was examined using thematic analysis. Results We interviewed 20 participants, including 5 obstetricians, 5 family physicians, 5 midwives, 4 nurses, and 1 policy expert. We found that while course-of-care-based midwifery funding is perceived to support high levels of midwifery client satisfaction and excellent clinical outcomes, it lacks flexibility. This limits opportunities for interprofessional collaboration and for midwives to use their knowledge and skills to respond to health system gaps. The physician fee-for-service funding model creates competition for births, has unintended consequences that limit midwives’ scope and access to hospital privileges, and fails to appropriately compensate physician consultants, particularly as midwifery volumes grow. Siloing of midwifery funding from hospital funding further restricts innovative contributions from midwives to respond to community healthcare needs. Conclusions Significant policy changes, such as adequate remuneration for consultants, possibly including salary-based physician funding; flexibility to compensate midwives for care beyond the existing course of care model; and a clearly articulated health human resource plan for sexual and reproductive care are needed to improve midwifery integration.

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Section: Resultsmentioning

confidence: 99%

The impact of funding models on the integration of Ontario midwives: a qualitative study

Darling,

Lemay,

Ejiwunmi

et al. 2023

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

show abstract

“…decision-making Employees' participation, autonomy and decisionmaking in change activities were investigated in four [49][50][51][52]. Hornung and Rousseau [50] examined how employees at two hospitals perceived their degree of autonomy, the importance of autonomy for proactivity and the decision to support change.…”

Section: Employee Participation Inmentioning

confidence: 99%

“…Darling et al [49] followed the implementation of a midwifery unit and identified six essential conditions: 1) innovation; 2) the outer context; 3) the inner context; 4) communication and influ-ence; 5) linkage between the design phase and the implementation stage, and 6) the implementation process. The results also showed that decision-making devolved to the frontline teams, leadership engagement, human resource issues, dedicated resources, internal communication, reinvention and development, and feedback on progress were associated with the success of the implementation process.…”

Section: Employee Participation Inmentioning

confidence: 99%

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Change competence: An integrative literature review

Reineholm,

Lundqvist,

Wallo

2024

WOR

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BACKGROUND: Organizations are in a state of continual evolution, driven by the relentless shifts in their external environments. Numerous theories have been proposed to understand the essential skills and capabilities for successful organizational change. Yet, there remains a gap in capturing a holistic view necessary to fully comprehend the dynamics of competence in today’s rapidly changing landscape. OBJECTIVE: This research aims to explore and consolidate the concept of ‘competence’ in the context of organizational change processes. METHODS: Employing an integrative literature review approach, a total of 3,230 studies were screened. Out of these, 32 studies were selected based on strict relevance and quality criteria, providing a robust foundation for the analysis. RESULTS: The findings reveal a multi-layered nature of organizational change, highlighting that the nature and prerequisites of change vary significantly across different organizational levels. By applying a competence lens, we discern how required competence during change are not uniform but rather vary depending on whether they are applied in an operational or strategic context. This demonstrates a nuanced, level-dependent variability in change competence across the organizational hierarchy. CONCLUSION: We conceptualize ‘change competence’ as a dual-faceted construct. It encompasses both the capacity to leverage existing organizational competence and the adeptness to develop new competence, thereby meeting the evolving demands imposed by both internal and external drivers of change. This comprehensive understanding paves the way for more effective strategies in managing organizational change.

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Promoting safety and role clarity among health professionals on Canada's First Alongside Midwifery Unit (AMU): A mixed-methods evaluation

et al. 2022

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Lessons learned from the implementation of Canada's first alongside midwifery unit: A qualitative explanatory study

Cited by 7 publications

References 7 publications

The impact of funding models on the integration of Ontario midwives: a qualitative study

The impact of funding models on the integration of Ontario midwives: a qualitative study

Change competence: An integrative literature review

Promoting safety and role clarity among health professionals on Canada's First Alongside Midwifery Unit (AMU): A mixed-methods evaluation

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