Be the Change that brings sustainability to MGP

Women and Birth(2023)

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摘要
Despite the well-known benefits of midwifery-led continuity of care, the majority of women do not have access to this model in Australia. Midwifery Group Practice (MGP) is often difficult to implement and once it is, it is often a challenge to sustain. Although the reasons for this are frequently multifactorial, determining what constitutes optimal management and leadership in order to sustain the model, may help to clarify what needs to change. Making MGP sustainable would improve the opportunity for midwives to provide continuity of care and make MGP available to more women. To determine the conditions that help to optimise the management of MGP in Australia by examining the role of managers in MGPs, and the attributes that enable them to orchestrate, lead, and sustain MGPs, as perceived by: upper and middle managers; Clinical Midwife Consultants (CMC’s); Midwifery Unit Managers (MUMs); and MGP midwives. This is a two-phase sequential mixed methods study. The first phase employed in-depth interviews and a focus group with MGP midwives, CMCs and Managers, and was used to design the second phase- a national survey of MGP midwives and managers. The interviews and focus group were analysed thematically. The quantitative data in the survey were analysed using descriptive analysis in IBM SPSS and the qualitative data were analysed using content analysis in NVivo. Thirty-one midwives and managers were interviewed. Although 790 MGP midwives and managers responded to the survey in phase two, 669 completed enough of the survey to be included. The midwife interviews revealed, the role of MGP manager was pivotal to the sustainability of MGP, and required someone with caring, nurturing and enabling attributes. The interviews and focus group with CMCs and managers showed the need for managers to practice ‘midwife centred management’ mirroring what is required for good midwifery care. Good midwifery care involved: a strong belief in feminist values and woman-centred care; being an advocate; inclusiveness; trust; the ability to form relationships; and excellent communication skills. In phase two the survey exposed a diverse landscape of how MGP was operationalised in Australia. While MGP midwives and managers agreed on many issues, there was discrepancy on whether midwives were paid adequately and on how management supported MGP. Both groups agreed however, that the most important attribute of an MGP manager was firstly to fully understand woman-centred care and MGP, and secondly to have an ability to trust the midwives and carefully manage them without micromanaging them. For those that had moved on from MGP both midwives and managers revealed that stress, poor work/life balance, and lack of support were contributing factors. For MGP to be sustained in Australia, it needs to be prioritised, nurtured, and embraced by the whole maternity care system. The role of MGP manager is pivotal to the sustainability of MGP, and requires someone with caring, nurturing and enabling attributes. MGP Managers should practice in a way that is midwife-centred and mimics good midwifery care. To improve sustainability, self-care practices, a supportive environment and good communication are essential within the MGP/manager group.
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