In the first yearof the project collaborating groups will systematically locate, review, and synthesise research studies of the provision and cultures of maternity care and the design of maternity care delivery systems. This will be synthesised in two parts; provision and cultures of FTPD and provision and cultures of routine intrapartum care for low risk women.
These findings will be published as a series of formal systematic reviews (qualitative and quantitative) and as a logistic model of care design pathways. The model will form part of the Framework.
Second year activities will locate and review existing tools and methods for assessing organisational climate, structure, and outcomes, and establish a new instrument to assess maternity care cultures and care delivery systems based on the reviews and identified tools. The new tool will include questions of interest to the Action service user and professional collaborators. These might include issues such as which professional groups provide what kind of care, how the system enables positive attitudes in care givers, how choice is presented and managed, and how information needs of service users are met. These, and any other relevant issues, will be discussed and agreed at an early stage with the Community of Practice members at an early stage.
The new tool will form the basis of a survey of all the countries that are signatories to the project. Issues to be explored include;
What are the characteristics of systems with high/low rates of FTPD?
What information do women get about FTPD measures in the different European countries?
What are the characteristics of systems with high/low rates of hospitalisation but low rates of childbirth intervention and of mortality and morbidity?
What are the social, ethical, organisational and clinical factors and discourses that frame settings with high rates, and low rates, FTPD uptake, or of routine interventions?
What is the nature of women’s ‘choice’ in maternity care provision, and particularly migrant women? What is the role of private health care provision in routine childbirth intervention?
The instrument development and testing will be written up for dissemation and publication.
In the third and fourth years, the survey will be rolled out to other European countries, and a detailed organisational, socio-economic, and cultural analysis will be carried out to characterise typologies of maternity care provision, including the funding arrangements, who holds authoritative knowledge, what hierarchies exist (including staff and service users) and how well actual practice mirrors official guidelines and protocols.
In the second year asnd onwards, grant applications will be prepared to follow up the emerging questions that arise from the work this work.
Insights from associated disciplines, such as organisational theorists, systems designers, human resources, human geographers, architects and facilities managers will be integrated into the work of the Organisation Design workgroup where this adds useful and innovative insights into the scientific endeavours of the group.