What determines optimal management of Midwifery Group Practice (MGP) in Australia

Abstract

The aim of this study was to determine the conditions that help to optimise the management of MGP in Australia. Methodology: A sequential, exploratory, mixed methods study was conducted in two phases, presented via four refereed publications, with a fifth under review. The first phase involved the collection and analysis of qualitative data. Specifically, interviews and a focus group were conducted with MGP midwives, midwifery managers and clinical midwifery consultants. The MGP midwives’ (n=8) interview data were analysed thematically and lexically for triangulation. The interviews (n=9) and focus group (n=14) with managers and clinical midwife consultants were analysed using inductive, reflexive, thematic analysis. The second phase involved the collection and analysis of qualitative and quantitative data. A national, cross-sectional survey was developed, informed by the findings from phase one, and distributed nationally (March 2021–July 2022). Quantitative data were analysed using descriptive analysis while qualitative data were analysed using content analysis. Results: From the interviews and focus group with managers and clinical midwifery consultants, an overarching theme of midwife-centred management was constructed; this described how the manager worked to put midwives at the centre, so that they in turn could put the woman at the centre of their care. The manager’s personal requirements were described as being woman- centred and demonstrating a strong belief in the MGP model. The manager should ‘midwife the midwives’ by carefully managing, trusting and valuing them and gain support beyond the model. In phase two, 690 survey responses met the inclusion criteria (579 MGP midwives, 68 MGP managers and 22 executive managers). The mean years of experience for MGP midwives was eight years and almost half had completed a Bachelor of Midwifery, which is almost twice the national average. Almost half the managers also managed other services along with the MGP, with many describing heavy workloads, competing demands and burnout. Midwives reduced their hours of work or resigned due to the work conditions and how the service was managed or supported. Managers left due to role changes, conflict with their manager, and limited support. The dataset from phase two served to clarify the best and worst aspects of working in an MGP. The former included participants’ relationships with women and their families via continuity of woman-centred carer; conversely, the latter included poor work–life balance and the impact on their family. To sustain the model, participants described the need to keep women central to MGP and have good relationships, understanding and support within and beyond the group, including adequate resources and staffing. The participants revealed the factors that helped and hindered a good working environment between MGP and mainstream service (core) midwives.

Date of Award	2024
Original language	English
Awarding Institution	Western Sydney University
Supervisor	Hannah Dahlen (Supervisor)