Workforce planning in midwifery: an overview of 8 years

Abstract

Birthrate Plus is a specifically midwifery-focused workforce planning methodology, which was designed to assess the numbers of midwives required to match the standard of providing all women with a minimum of one-to-one care from a midwife during labour. It uses a number of workforce planning strategies, such as a classification system for intrapartum care, recording of actual midwife hours required per category, further recording of all other maternal/midwife activity within hospital and community services, including home births, and uses a professional judgment and ‘expert group’ approach to assessing midwife hours per defined client need or activity. This article provides an outline of the theoretical framework and an overview of the results of Birthrate Plus studies within the NHS and beyond since 2001.

Evidence on the use of Birthrate Plus® to guide safe staffing in maternity services – a systematic scoping review

“…While 16 of the 23 studies were assessed as offering some evidence of the useability of the tool, the evidence was almost exclusively based on the conclusions or assertions of authors rather than direct empirical evidence. [1, 2] [18] [20, 22, 26-30] [33–38] No empirical evidence about staff experiences of using the system, or the time involved, was found, although several reports referred to the system’s usefulness and ease of use. [18, 20, 28, 34, 35] There was no empirical evidence that staff felt the recommended staffing levels were appropriate.…”

“…[1,2] [18] [20,22,[26][27][28][29][30] [ [33][34][35][36][37][38] No empirical evidence about staff experiences of using the system, or the time involved, was found, although several reports referred to the system's usefulness and ease of use. [18,20,28,34,35] There was no empirical evidence that staff felt the recommended staffing levels were appropriate. The NICE statement of endorsement did not provide any empirical evidence but determined that the tools (both for establishment setting and the real-time acuity assessment) addressed many of the factors needed in setting maternity staff establishments.…”

“…Impact of BR+ based establishments on planned / achieved staffing Birthrate Plus is said to have usefully guided changes in staffing in response to change in service delivery [28] and led to increased staffing. [18] Birthrate Plus is widely used [36] and several studies showed estimated staffing requirements that differed from existing levels and so would have led to change if implemented. [2,36,38] Birthrate Plus has been used in simulation studies to compare establishment staffing with demand [39] and has also been used to underpin escalation tools for delivery suite prompting an operational response to maintain appropriate staffing levels.…”

“…The developers have published a number of papers outlining current methods and its application in maternity settings, but details of the tools' development and underpinning assumptions are sparse. [1] [14] [18][19][20] They report that formulas have been updated and extended over time as the methodology has developed [14], but such changes remain unpublished. A version of the tool has been developed to monitor fluctuations in workload and midwife availability in real time via an App.…”

Women׳s views on partnership working with midwives during pregnancy and childbirth

“…Birthrate Plus ® , a workload planning model, has been developed for use in maternity care. Where this has been implemented, organisations have been able to present a robust case for increasing staffing numbers and have presented options for workforce redesign (Ball et al, 2010). However, it has been suggested that this process is time consuming and expensive to implement and does not take adequate account of the needs of rural maternity services, with data across regions said to not be comparable because assessments are not undertaken concurrently (Midwifery 2020 Workforce andWorkload Final Report, 2010).…”