The challenges of change : planning a midwifery model of care
- Publication Type:
- Thesis
- Issue Date:
- 2005
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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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