Australian maternity reform through clinical redesign.

Area of Science:

• Maternal Health
• Healthcare Management
• Midwifery Models of Care

Background:

• Australian maternity reforms aim to enhance access, safety, and quality of care.
• Caseload midwifery models offer continuity of care but face significant implementation resistance in Australia.
• Current access to caseload midwifery is often limited, tokenistic, and serves a small proportion of women.

Purpose of the Study:

• To describe a clinical redesign introducing caseload midwifery care at a tertiary maternity hospital.
• To evaluate the implementation of caseload midwifery for 1500 women of all risk levels.
• To identify facilitators and barriers encountered during the introduction of this model.

Main Methods:

• A case study approach was used at a metropolitan tertiary referral maternity hospital in Sydney.
• Caseload midwifery care was implemented under randomised trial conditions.
• Organizational quality and safety tools were utilized to facilitate the redesign process.

Main Results:

• Caseload midwifery care was provided to 1500 women, with half of publicly insured women receiving midwifery group practice care.
• The study identified various facilitators and barriers across workforce, operational, and political contexts.
• Implementation involved a major clinical redesign of midwifery services.

Conclusions:

• The implementation of caseload midwifery care for a large cohort of women was achieved through a major clinical redesign.
• Understanding workforce, operational, and political factors is crucial for successful introduction of such models.
• This case study provides insights into overcoming resistance to caseload midwifery in Australia.