Reflective, pragmatic, and reactive decision-making by maternity service providers during the SARS-CoV-2 pandemic health system shock: a qualitative, grounded theory analysis.
- Publisher:
- BMC
- Publication Type:
- Journal Article
- Citation:
- BMC Pregnancy Childbirth, 2023, 23, (1), pp. 368
- Issue Date:
- 2023-05-20
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Field | Value | Language |
---|---|---|
dc.contributor.author | Silverio, SA | |
dc.contributor.author | De Backer, K | |
dc.contributor.author | Brown, JM | |
dc.contributor.author | Easter, A | |
dc.contributor.author | Khazaezadeh, N | |
dc.contributor.author | Rajasingam, D | |
dc.contributor.author |
Sandall, J https://orcid.org/0000-0003-2000-743X |
|
dc.contributor.author | Magee, LA | |
dc.date.accessioned | 2023-10-04T02:54:30Z | |
dc.date.available | 2023-04-24 | |
dc.date.available | 2023-10-04T02:54:30Z | |
dc.date.issued | 2023-05-20 | |
dc.identifier.citation | BMC Pregnancy Childbirth, 2023, 23, (1), pp. 368 | |
dc.identifier.issn | 1471-2393 | |
dc.identifier.issn | 1471-2393 | |
dc.identifier.uri | http://hdl.handle.net/10453/172460 | |
dc.description.abstract | BACKGROUND: Pregnant and postpartum women were identified as having particular vulnerability to severe symptomatology of SARS-CoV-2 infection, so maternity services significantly reconfigured their care provision. We examined the experiences and perceptions of maternity care staff who provided care during the pandemic in South London, United Kingdom - a region of high ethnic diversity with varied levels of social complexity. METHODS: We conducted a qualitative interview study, as part of a service evaluation between August and November 2020, using in-depth, semi-structured interviews with a range of staff (N = 29) working in maternity services. Data were analysed using Grounded Theory analysis appropriate to cross-disciplinary health research. ANALYSIS & FINDINGS: Maternity healthcare professionals provided their views, experiences, and perceptions of delivering care during the pandemic. Analysis rendered three emergent themes regarding decision-making during reconfigured maternity service provision, organised into pathways: 1) 'Reflective decision-making'; 2) 'Pragmatic decision-making'; and 3) 'Reactive decision-making'. Whilst pragmatic decision-making was found to disrupt care, reactive-decision-making was perceived to devalue the care offered and provided. Alternatively, reflective decision-making, despite the difficult working conditions of the pandemic, was seen to benefit services, with regards to care of high-quality, sustainability of staff, and innovation within the service. CONCLUSIONS: Decision-making within maternity care was found to take three forms - where at best changes to services could be innovative, at worst they could cause devaluation in care being delivered, and more often than not, these changes were disruptive. With regard to positive changes, healthcare providers identified staff empowerment, flexible working patterns (both for themselves and collectively as teams), personalised care delivery, and change-making in general, as key areas to capitalise on current and ongoing innovations borne out of the pandemic. Key learnings included a focus on care-related, meaningful listening and engagement of staff at all levels, in order to drive forward high-quality care and avoid care disruption and devaluation. | |
dc.format | Electronic | |
dc.language | eng | |
dc.publisher | BMC | |
dc.relation.ispartof | BMC Pregnancy Childbirth | |
dc.relation.isbasedon | 10.1186/s12884-023-05641-2 | |
dc.rights | info:eu-repo/semantics/openAccess | |
dc.rights | © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data | |
dc.subject | 1110 Nursing, 1114 Paediatrics and Reproductive Medicine, 1117 Public Health and Health Services | |
dc.subject.classification | Obstetrics & Reproductive Medicine | |
dc.subject.classification | 3215 Reproductive medicine | |
dc.subject.classification | 4204 Midwifery | |
dc.subject.mesh | Female | |
dc.subject.mesh | Pregnancy | |
dc.subject.mesh | Humans | |
dc.subject.mesh | Maternal Health Services | |
dc.subject.mesh | SARS-CoV-2 | |
dc.subject.mesh | Grounded Theory | |
dc.subject.mesh | Pandemics | |
dc.subject.mesh | COVID-19 | |
dc.subject.mesh | Qualitative Research | |
dc.subject.mesh | Humans | |
dc.subject.mesh | Pregnancy | |
dc.subject.mesh | Qualitative Research | |
dc.subject.mesh | Maternal Health Services | |
dc.subject.mesh | Female | |
dc.subject.mesh | Pandemics | |
dc.subject.mesh | Grounded Theory | |
dc.subject.mesh | COVID-19 | |
dc.subject.mesh | SARS-CoV-2 | |
dc.subject.mesh | Female | |
dc.subject.mesh | Pregnancy | |
dc.subject.mesh | Humans | |
dc.subject.mesh | Maternal Health Services | |
dc.subject.mesh | SARS-CoV-2 | |
dc.subject.mesh | Grounded Theory | |
dc.subject.mesh | Pandemics | |
dc.subject.mesh | COVID-19 | |
dc.subject.mesh | Qualitative Research | |
dc.title | Reflective, pragmatic, and reactive decision-making by maternity service providers during the SARS-CoV-2 pandemic health system shock: a qualitative, grounded theory analysis. | |
dc.type | Journal Article | |
utslib.citation.volume | 23 | |
utslib.location.activity | England | |
utslib.for | 1110 Nursing | |
utslib.for | 1114 Paediatrics and Reproductive Medicine | |
utslib.for | 1117 Public Health and Health Services | |
pubs.organisational-group | /University of Technology Sydney | |
pubs.organisational-group | /University of Technology Sydney/Faculty of Health | |
pubs.organisational-group | /University of Technology Sydney/Faculty of Health/Midwifery | |
utslib.copyright.status | open_access | * |
dc.date.updated | 2023-10-04T02:54:29Z | |
pubs.issue | 1 | |
pubs.publication-status | Published online | |
pubs.volume | 23 | |
utslib.citation.issue | 1 |
Abstract:
BACKGROUND: Pregnant and postpartum women were identified as having particular vulnerability to severe symptomatology of SARS-CoV-2 infection, so maternity services significantly reconfigured their care provision. We examined the experiences and perceptions of maternity care staff who provided care during the pandemic in South London, United Kingdom - a region of high ethnic diversity with varied levels of social complexity. METHODS: We conducted a qualitative interview study, as part of a service evaluation between August and November 2020, using in-depth, semi-structured interviews with a range of staff (N = 29) working in maternity services. Data were analysed using Grounded Theory analysis appropriate to cross-disciplinary health research. ANALYSIS & FINDINGS: Maternity healthcare professionals provided their views, experiences, and perceptions of delivering care during the pandemic. Analysis rendered three emergent themes regarding decision-making during reconfigured maternity service provision, organised into pathways: 1) 'Reflective decision-making'; 2) 'Pragmatic decision-making'; and 3) 'Reactive decision-making'. Whilst pragmatic decision-making was found to disrupt care, reactive-decision-making was perceived to devalue the care offered and provided. Alternatively, reflective decision-making, despite the difficult working conditions of the pandemic, was seen to benefit services, with regards to care of high-quality, sustainability of staff, and innovation within the service. CONCLUSIONS: Decision-making within maternity care was found to take three forms - where at best changes to services could be innovative, at worst they could cause devaluation in care being delivered, and more often than not, these changes were disruptive. With regard to positive changes, healthcare providers identified staff empowerment, flexible working patterns (both for themselves and collectively as teams), personalised care delivery, and change-making in general, as key areas to capitalise on current and ongoing innovations borne out of the pandemic. Key learnings included a focus on care-related, meaningful listening and engagement of staff at all levels, in order to drive forward high-quality care and avoid care disruption and devaluation.
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