http://hdl.handle.net/2328/26253 2013-05-03T08:37:04Z http://hdl.handle.net/2328/26687 Title: Maternity funding and workforce reform: strategies for better design, better value, better health and equity Authors: Donnellan-Fernandez, Roslyn Elizabeth; Newman, Lareen Ann; Reiger, Kerreen; Tracy, Sally Abstract: The purpose of this paper is to make transparent the connections between funding, workforce issues, and clinical outcomes in Australian maternity services, including their relationship to Casemix. It will also examine how these factors intersect and impact existing service models, emerging service models and, most importantly, contemporary consumer demand, community expectations of health care, and health outcomes for women and babies in the short and long term. Central to this purpose, the paper offers a dual critique: a) that the principles, foundation and model for funding maternity service provision in Australia within acute hospital services is seriously flawed and a significant driver for increased expenditure as well as unnecessary clinical interventions in healthy women and babies, and short term adverse health outcomes for mothers, babies and families; it also results in a larger, hitherto unacknowledged systems legacy with significant implications for long term health and economic outcomes of the population, including future health system management of the burden of chronic disease; b) that there is a current mismatch between policy and funding structure whereby biomedical/acute care models of service delivery for healthy pregnant women and babies are broadly privileged as the dominant paradigm for maternity services. This constitutes incoherent health policy and is inconsistent with both medical research and evidence- based ‘best practice,’ including a population health approach to delivery of maternity services and the view that good maternity service provision can act as a population level preventative health strategy. The paper uses Ulrich’s Systematic Boundary Critique (1) as a framework to make transparent the limitations and dysfunction of the current system and to propose an alternative design which has the capacity to improve equity, access, clinical outcomes, and reconfiguration and utilization of the skilled midwifery workforce. The new design can contribute reduced health care costs, labour force efficiency, staff retention, and economically sustainable services. The paper concludes that a national approach to policy and structural funding reform that relocates mainstream maternity services for healthy women and babies within a primary health care paradigm is urgently required in Australia, and is aligned with widespread consumer lobbying for such reform. 2013-04-10T00:00:00Z http://hdl.handle.net/2328/26674 Title: Acceptability of participatory social network analysis for problem-solving in Australian Aboriginal health service partnerships Authors: Fuller, Jeffrey; Hermeston, Wendy; Passey, Megan; Fallon, Tony; Muyambi, Kuda Abstract: While participatory social network analysis can help health service partnerships to solve problems, little is known about its acceptability in cross-cultural settings. We conducted two case studies of chronic illness service partnerships in 2007 and 2008 to determine whether participatory research incorporating social network analysis is acceptable for problem-solving in Australian Aboriginal health service delivery. Methods: Local research groups comprising 13–19 partnership staff, policy officers and community members were established at each of two sites to guide the research and to reflect and act on the findings. Network and work practice surveys were conducted with 42 staff, and the results were fed back to the research groups. At the end of the project, 19 informants at the two sites were interviewed, and the researchers conducted critical reflection. The effectiveness and acceptability of the participatory social network method were determined quantitatively and qualitatively. Results: Participants in both local research groups considered that the network survey had accurately described the links between workers related to the exchange of clinical and cultural information, team care relationships, involvement in service management and planning and involvement in policy development. This revealed the function of the teams and the roles of workers in each partnership. Aboriginal workers had a high number of direct links in the exchange of cultural information, illustrating their role as the cultural resource, whereas they had fewer direct links with other network members on clinical information exchange and team care. The problem of their current and future roles was discussed inside and outside the local research groups. According to the interview informants the participatory network analysis had opened the way for problem-solving by “putting issues on the table”. While there were confronting and ethically challenging aspects, these informants considered that with flexibility of data collection to account for the preferences of Aboriginal members, then the method was appropriate in cross-cultural contexts for the difficult discussions that are needed to improve partnerships. Conclusion: Critical reflection showed that the preconditions for difficult discussions are, first, that partners have the capacity to engage in such discussions, second, that partners assess whether the effort required for these discussions is balanced by the benefits they gain from the partnership, and, third, that “boundary spanning” staff can facilitate commitment to partnership goals. 2012-06-10T00:00:00Z http://hdl.handle.net/2328/26660 Title: Autonomous private midwifery practice: a retrospective 1994-2000 Authors: Donnellan-Fernandez, Roslyn Elizabeth Abstract: This paper provides an overview of an independent midwifery practice conducted in metropolitan Adelaide for the years 1994-2000. The solo caseload practice provides prenatal, intrapartum and postnatal services for approximately 24-30 families per year utilizing the 'relational emancipatory model of midwifery care' developed by the author. A distinguishing feature of this model is continuity of midwife carer throughout the childbearing continuum. Outcomes for 117 women and babies are presented. The relationship of isolation to private midwifery practice in Australia is considered, further developing the themes of personal, professional, structural and cultural challenges to autonomous practice. 2000-11-01T00:00:00Z http://hdl.handle.net/2328/26656 Title: Personal, professional, structural and cultural challenges to autonomous practice - a midwife's perspective Authors: Donnellan-Fernandez, Roslyn Elizabeth Abstract: This paper examines the status and some of the issues surrounding autonomous midwifery practice in South Australia in 1996. It is based on the author's reflections and lived experience as an intermittently self-employed midwife practitioner within the Adelaide community during the past three years. Additionally, the paper examines recent national and state reports and recommendations on the maternity services. The principal themes that will be explored include personal, professional, structural and cultural challenges in achieving autonomous midwifery practice. Whilst explicit exploration of the theoretical orientations underlying this paper are absent, the primary influences are those of critical theory, (particularly the works of Michel Foucault) and socialist feminist theory (particularly the work of Alison Jaggar). 1996-11-01T00:00:00Z