The challenges of change : planning a midwifery model of care

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This thesis is about the challenge of change in maternity services. It examines the factors that facilitate and hinder the implementation of new models of midwifery care. At the time that the midwifery model of care described in this thesis was being planned, a great deal had been written regarding the problems with Australian maternity services. Such was the level of dissatisfaction with maternity services that government inquiries had been held and reports were produced recommending changes for improvement. Maternity services at the national and local level were in a state of transition, slowly addressing the recommendations from such inquiries and reports. It was in this environment of transition that a midwifery model of care was being planned. The midwifery model of care aimed to provide comprehensive maternity care for women of low risk, who did not hold health insurance and would incorporate childbirth and parenting education and support as well as care throughout the childbearing experience. Midwives would work collaboratively with General Practitioners in the community and provide midwifery led care. · The purpose of the project described in this thesis was to record and analyse the process of change associated with planning and implementing a midwifery model of care. This thesis is as much about effecting organisational change as it is about midwifery and exploring the conditions that are needed to plan and implement new models of midwifery care. This thesis explicates the factors that hindered the planning and implementation of the model, particularly the barriers to shifting boundaries of practice between groups of health professionals. · This thesis draws on Kotter's work on organisational change to describe and analyse the planning ·process in order to gain a better understanding of what it takes to achieve organisational change. An emerging theme from the data was the interplay between creating a sense of urgency to facilitate change and limiting obstacles to block the vision. These activities revealed the continual struggle that occurred as various strategies were put into place to overcome obstacles and defuse resistance to change. The conclusion emphasises that while the midwifery model of care was not implemented, change had been achieved through a shuffling rather than a shifting of the professional boundaries between 'key players', namely the midwives, General Practitioners and obstetricians. Changing allegiances, partnerships, relationship and power had changed the status quo. In addition, the midwives had developed professionally leading to an increased capacity to continue the process of achieving the midwifery model of care.
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