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Labouring Together: Clinicians’ Experiences of “Working Together To Get The Best Outcomes” in Maternity Care

  • Vanessa Watkins
    Affiliations
    School of Nursing and Midwifery, Centre for Quality and Patient Safety, Institute for Health Transformation, Deakin University, Geelong, Australia

    School of Psychology, Deakin University, Burwood, Australia
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  • Cate Nagle
    Affiliations
    Centre for Nursing and Midwifery Research, College of Healthcare Sciences, James Cook University, Queensland, Australia, Townsville, Australia

    Townsville Hospital and Health Service, Townsville, Australia
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  • Bridie Kent
    Affiliations
    School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
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  • Maryann Street
    Affiliations
    School of Nursing and Midwifery, Centre for Quality and Patient Safety, Institute for Health Transformation, Deakin University, Geelong, Australia

    Centre for Quality and Patient Safety – Eastern Health Partnership, Box Hill, Australia
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  • Alfred Deakin Alison Hutchinson
    Affiliations
    School of Nursing and Midwifery, Centre for Quality and Patient Safety, Institute for Health Transformation, Deakin University, Geelong, Australia

    Centre for Quality and Patient Safety – Monash Health Partnership, Clayton, Australia
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      Introduction

      Multiple investigations have determined that poor interprofessional collaboration has been detrimental to the safety and experience of maternity care, as evidenced in the publication of the recent Ockenden review in the UK. The Labouring Together study was conducted to explore women's and clinicians' perceptions and experiences of collaboration in maternity care, using a conceptual theory of collaboration to identify barriers and enablers in the context of Victoria, Australia.

      Methods

      A sequential, mixed-methods, multi-site case study approach was used to explore collaboration and shared decision-making in maternity care in four diverse case studies of public and private hospitals. Cross-sectional surveys were conducted in each case, using validated scales to determine midwives’, obstetrician’s and GPs’ assessment of organisational context and attitudes toward collaboration, followed by in-depth interviews to explore their perceptions and experiences.

      Results

      Participants rated the context of each case study similarly for the provision of woman-centred care, and whilst the attitudes of most participants were positive toward collaboration, midwives were found to have a significantly more positive attitude than obstetricians (p<.001 95% CI 2.64-7.93) and GPs (p<.001 95% CI 5.48-12.10). The conceptual framework of Working Together to Get The Best Outcomes emerged from inductive analysis, with major subthemes of ‘Organisation of care: working for the organisation’ and ‘Partnering in care: working together with women’. Interprofessional tensions are avoided through professional altruism and positive role-modelling of interprofessional respect and trust. However, multiple barriers to effective collaboration in maternity care were identified; and whilst participants agreed that women should have autonomy for collaborative decision-making, most identified barriers to achieving this ideal.

      Conclusion

      Results of the Labouring Together study indicate that although individual attitudes toward collaboration are largely positive, fundamental barriers to collaboration in maternity care remain, and shared decision-making with women is not routine practice in Victoria, Australia.
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