Maternity services for rural and remote Australia: barriers to operationalising national policy

Longman, J; Kornelsen, J; Pilcher, J; Kildea, S; Kruske, S; Grzybowski, S; Robin, S; Rolfe, M; Donoghue, D; Morgan, GG; Barclay, L

Maternity services for rural and remote Australia: barriers to operationalising national policy

Longman, J Kornelsen, J Pilcher, J Kildea, S Kruske, S

Grzybowski, S Robin, S Rolfe, M Donoghue, D Morgan, GG Barclay, L

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Publication Type:: Journal Article
Citation:: Health Policy, 2017, 121 (11), pp. 1161 - 1168
Issue Date:: 2017-11-01

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Field	Value	Language
dc.contributor.author	Longman, J	en_US
dc.contributor.author	Kornelsen, J	en_US
dc.contributor.author	Pilcher, J	en_US
dc.contributor.author	Kildea, S	en_US
dc.contributor.author	Kruske, S https://orcid.org/0000-0002-2317-3954	en_US
dc.contributor.author	Grzybowski, S	en_US
dc.contributor.author	Robin, S	en_US
dc.contributor.author	Rolfe, M	en_US
dc.contributor.author	Donoghue, D	en_US
dc.contributor.author	Morgan, GG	en_US
dc.contributor.author	Barclay, L https://orcid.org/0000-0002-9345-3468	en_US
dc.date.available	2017-09-16	en_US
dc.date.issued	2017-11-01	en_US
dc.identifier.citation	Health Policy, 2017, 121 (11), pp. 1161 - 1168	en_US
dc.identifier.issn	0168-8510	en_US
dc.identifier.uri	http://hdl.handle.net/10453/126911
dc.description.abstract	© 2017 Elsevier B.V. Introduction In Australia, many small birthing units have closed in recent years, correlating with adverse outcomes including a rise in the number of babies born before arrival to hospital. Concurrently, a raft of national policy and planning documents promote continued provision of rural and remote maternity services, articulating a strategic intent for services to provide responsive, woman-centred care as close as possible to a woman's home. The aims of this paper are to contribute to an explanation of why this strategic intent is not realised, and to investigate the utility of an evidence based planning tool (the Toolkit) to assist with planning services to realise this intent. Methods Interviews, focus groups and a group information session were conducted involving 141 participants in four Australian jurisdictions. Field notes and reports were thematically analysed. Results We identified barriers that helped explain the gap between strategic intent and services on the ground. These were absence of informed leadership; lack of knowledge of contemporary models of care and inadequate clinical governance; poor workforce planning and use of resources; fallacious perceptions of risk; and a dearth of community consultation. In this context, the implementation of policy is problematic without tools or guidance. Conclusions Barriers to operationalising strategic intent in planning maternity services may be alleviated by using evidence based planning tools such as the Toolkit.	en_US
dc.relation.ispartof	Health Policy	en_US
dc.relation.isbasedon	10.1016/j.healthpol.2017.09.012	en_US
dc.subject.classification	Health Policy & Services	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Midwifery	en_US
dc.subject.mesh	Pregnancy	en_US
dc.subject.mesh	Health Policy	en_US
dc.subject.mesh	Ethnic Groups	en_US
dc.subject.mesh	Rural Health	en_US
dc.subject.mesh	Hospitals, Maternity	en_US
dc.subject.mesh	Maternal Health Services	en_US
dc.subject.mesh	Australia	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Evidence-Based Practice	en_US
dc.subject.mesh	Workforce	en_US
dc.title	Maternity services for rural and remote Australia: barriers to operationalising national policy	en_US
dc.type	Journal Article
utslib.citation.volume	11	en_US
utslib.citation.volume	121	en_US
utslib.for	1117 Public Health and Health Services	en_US
utslib.for	1605 Policy and Administration	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
utslib.copyright.status	closed_access
pubs.issue	11	en_US
pubs.publication-status	Published	en_US
pubs.volume	121	en_US

Abstract:

© 2017 Elsevier B.V. Introduction In Australia, many small birthing units have closed in recent years, correlating with adverse outcomes including a rise in the number of babies born before arrival to hospital. Concurrently, a raft of national policy and planning documents promote continued provision of rural and remote maternity services, articulating a strategic intent for services to provide responsive, woman-centred care as close as possible to a woman's home. The aims of this paper are to contribute to an explanation of why this strategic intent is not realised, and to investigate the utility of an evidence based planning tool (the Toolkit) to assist with planning services to realise this intent. Methods Interviews, focus groups and a group information session were conducted involving 141 participants in four Australian jurisdictions. Field notes and reports were thematically analysed. Results We identified barriers that helped explain the gap between strategic intent and services on the ground. These were absence of informed leadership; lack of knowledge of contemporary models of care and inadequate clinical governance; poor workforce planning and use of resources; fallacious perceptions of risk; and a dearth of community consultation. In this context, the implementation of policy is problematic without tools or guidance. Conclusions Barriers to operationalising strategic intent in planning maternity services may be alleviated by using evidence based planning tools such as the Toolkit.

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http://hdl.handle.net/10453/126911