NATIONAL GUIDANCE on COLLABORATIVE Maternity Care
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NATIONAL GUIDANCE ON COLLABORATIVE Maternity Care www.nhmrc.gov.au WORKING TO BUILD A HEALTHY AUSTRALIA © Commonwealth of Australia 2010 Printed document This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission from the Commonwealth. Requests and inquiries concerning reproduction and rights should be addressed to the Commonwealth Copyright Administration, Attorney-General’s Department, Robert Garran Offices, National Circuit, Barton ACT 2600 or posted at www.ag.gov.au/cca. ISBN Print: 1864965169 Electronic document This work is copyright. You may download, display, print and reproduce this material in unaltered form only (retaining this notice) for your personal, noncommercial use or use within your organisation. Apart from any use as permitted under the Copyright Act 1968, all other rights are reserved. Requests and inquiries concerning reproduction and rights should be addressed to Commonwealth Copyright Administration, Attorney-General’s Department, National Circuit, Barton ACT 2600 or posted at www. ag.gov.au/cca. ISBN Online: 186496510x NHMRC (National Health and Medical Research Council) (2010). National Guidance on Collaborative Maternity Care, NHMRC, Canberra. Contact: National Health and Medical Research Council Level 1 16 Marcus Clarke Street Canberra ACT 2601 GPO Box 1421 Canberra ACT 2601 Ph: 61 2 6217 9000 Fax: 61 2 6217 9100 Email: [email protected] NHMRC Reference code: CP124 Production by Biotext Pty Ltd, Canberra Acknowledgments The NHMRC would like to acknowledge the support provided by the following organisations, with particular thanks to their representatives who made up the project’s reference group. These representatives recommend the National Guidance on Collaborative Maternity Care to all those involved or interested in maternity services. • Australian College of Midwives Associate Professor Hannah Dahlen and Professor Sally Tracy • Australian College of Rural and Remote Medicine Associate Professor Ruth Stewart • Australian Commission on Safety and Quality in Health Care Professor Chris Baggoley (Chair) • Australian Private Midwives Association Ms Elizabeth Wilkes • Belmont Birthing Service NSW Ms Kelley Lennon • Childbirth Australia Ms Debbie Slater • CRANAplus Professor Sue Kildea • Maternity Coalition Mr Bruce Teakle • Royal Australian College of General Practitioners Dr Morton Rawlin • Royal Australian College of Obstetricians and Gynaecologists Dr Ted Weaver and Professor Alec Welsh • Women’s Hospitals Australasia Ms Elizabeth Chatham Thanks to the following NHMRC project team their for ongoing support: • Ms Cathy Mitchell • Ms Gill Hall • Ms Indiana Holley • Ms Sarah Blackledge NATIONAL GUIDANCE ON COLLABORATIVE MATERNITY CARE Contents Contents Acronyms and abbreviations vii Executive Summary 1 Introduction 5 1 Maternity care collaboration: definition and principles 7 1.1 Collaboration in health care 8 1.2 Collaborative maternity care in Australia 8 1.2.1 Definition of maternity care collaboration 9 1.2.2 Principles of maternity care collaboration 9 1.3 Diverse collaborations for diverse needs 9 1.3.1 Primary, secondary and tertiary care 10 1.3.2 Models of primary maternity care 11 1.3.3 Models of private maternity care in Australia 12 2 Key elements of collaboration: translating evidence into clinical practice 13 2.1 Woman-centred care and communication 13 2.2 Communication among professionals 16 2.3 Awareness of disciplines and autonomy 17 2.4 Responsibility and accountability 18 2.5 Cooperation and coordination 19 2.6 Mutual trust and respect 19 2.7 Policy, procedures and protocols 20 2.8 Interprofessional learning 21 2.9 Organisational support 22 2.10 Systems 23 3 Establishing collaboration 25 3.1 Steps to establishing collaborative practice 25 3.1.1 Define the context of service delivery 25 3.1.2 Clarify the services and skill mix of partners 26 3.1.3 Identify general and specific issues for women in the service region 26 3.1.4 Identify how collaboration can work 27 3.1.5 Negotiate ‘service’ policies, activities and issues 27 3.2 Considering collaborative care: issues common across regions and services 28 3.2.1 Roles and responsibilities 29 3.2.2 Shared documentation 29 3.2.3 Transfer plans 29 3.2.4 Care pathways 29 3.2.5 Access to hospitals 29 3.2.6 Credentialing 30 NATIONAL HEALTH AND MEDICAL RESEARCH COUNCIL iii NATIONAL GUIDANCE ON COLLABORATIVE MATERNITY CARE Contents Considering collaborative care: issues common across regions and services (continued) 3.2.7 Hospital bookings 30 3.2.8 Admission status 30 3.2.9 Postnatal care 30 3.2.10 Competition 30 3.2.11 Dealing with conflict 31 3.3 Considering collaborative care in different settings 32 3.3.1 Issues for midwives working privately 32 3.3.2 Issues for nongovernment organisations or Aboriginal medical services 33 3.3.3 Rural and remote areas 33 3.3.4 Metropolitan public hospitals 36 3.3.5 Private hospitals 37 4 Clinical resources for collaboration 39 4.1 Current Australian guidelines 39 4.2 Clinical practice guidelines 39 4.3 Establishing protocols to guide clinical practice 40 4.3.1 Consumer involvement 40 4.3.2 Identifying risk 42 4.3.3 Integrated care pathways 43 4.3.4 Communication: meetings and documentation 43 4.3.5 Other tools 43 4.4 Potential clinical resources 44 5 Monitoring and evaluation 45 5.1 Individual professional development and review of practice 45 5.2 Peer and case review 45 5.3 Audit processes 46 5.4 Clinical practice guidelines for perinatal mortality 47 Appendix 1 Guidance development process 49 Appendix 2 Case studies of existing collaborative models 57 Appendix 3 Summary pamphlet for women 71 Glossary 73 References 75 Tables Table 4.1 Summary of codes for care from the Australian College of Midwives guidelines 40 Table A1.1 Stakeholder consultations 52 Figures Figure 2.1 The process of making an informed choice 15 Figure 4.1 Decision diagram for use by midwives 41 iv NATIONAL HEALTH AND MEDICAL RESEARCH COUNCIL NATIONAL GUIDANCE ON COLLABORATIVE MATERNITY CARE Contents Boxes Box 1.1 Definition of maternity care collaboration 7 Box 1.2 Principles of maternity care collaboration 7 Box 1.3 Terminology used in the Guidance 9 Box 2.1 Key elements of maternity care collaboration 13 Box 2.2 Important terminology for woman-centred communication 14 Box 2.3 Examples of approaches that support woman-centred communication 16 Box 2.4 Examples of approaches that support interprofessional communication 17 Box 2.5 Examples of approaches that show interdisciplinary awareness and autonomy 18 Box 2.6 Examples of approaches that highlight responsibility and accountability 18 Box 2.7 Examples of approaches that show cooperation and coordination 19 Box 2.8 Examples of approaches that show mutual trust and respect among professionals 20 Box 2.9 Examples of approaches that show the use of policy, procedures and protocols to improve collaboration 21 Box 2.10 Examples of approaches that support interprofessional learning 22 Box 2.11 Examples of approaches that show organisational support 23 Box 2.12 Examples of approaches that show the use of supporting systems 24 Box 3.1 Key areas to consider when establishing collaboration 25 Box 3.2 An example of establishing a collaborative maternity unit 28 Box 3.3 Access to hospitals 28 Box 3.4 An example of conflict in the workplace 32 Box 3.5 Example of collaboration influencing cultural change in maternity care 32 Box 3.6 Example of private midwives collaborating with a public hospital 33 Box 5.1 Audit and review in the collaborative setting 45 Box 5.2 Steps to consider when evaluating collaboration 47 NATIONAL HEALTH AND MEDICAL RESEARCH COUNCIL v NATIONAL GUIDANCE ON COLLABORATIVE MATERNITY CARE Acronyms and abbreviations ■ Acronyms and abbreviations ACM Australian College of Midwives CRANAplus the professional body for remote and isolated health providers DoHA Australian Government Department of Health and Ageing GP General Practitioner the Guidance National Guidance on Collaborative Maternity Care MOU Memorandum of Understanding NHMRC National Health and Medical Research Council RANZCOG Royal Australian and New Zealand College of Obstetricians and Gynaecologists NATIONAL HEALTH AND MEDICAL RESEARCH COUNCIL vii NATIONAL GUIDANCE ON COLLABORATIVE MATERNITY CARE Executive summary ■ Executive Summary The National Guidance on Collaborative Maternity Care (the Guidance) has been developed by the National Health and Medical Research Council (NHMRC) to provide a resource to support collaborative maternity care in Australia. It is intended to assist maternity service professionals set in place and maintain collaborative arrangements appropriate for the local context and the model of care. In this way, it will support the delivery of maternity care and ensure that women receive access to appropriate expertise and treatment, as the need arises. Maternity care collaboration: definition and principles A shared definition and understanding of what collaboration means for maternity care is an important first step to establishing successful collaborations. The following definition and principles of maternity care collaboration have been developed by a range of maternity care service providers and users for this Guidance document. Definition In maternity care, collaboration is a dynamic process of facilitating communication, trust and pathways that enable health professionals to provide safe, woman-centred care. Collaborative maternity care enables women to be active participants in their care. Collaboration includes clearly defined roles and responsibilities for everyone involved in the woman’s care, especially for the person the woman sees as her maternity care coordinator. Principles 1. Maternity care collaboration places the woman at the centre of her own care, while supporting the professionals who are caring for her (her carers). Such care is coordinated according to the woman’s needs, including her cultural, emotional, psychosocial and clinical needs. 2. Collaboration enables women to choose care that is based on the best evidence and is appropriate for themselves and for their local environment.