Abstract
BackgroundState-wide surveys of recent mothers conducted over the past decade in Victoria, one state of Australia, have identified that women are consistently less satisfied with the care they received in hospital following birth compared with other aspects of maternity care. Little is known of caregivers' perspectives on the provision ofhospital postnatal care: how care is organised and provided in different hospitals; what constrains the provision of postnatal care (apart from funding) and what initiatives are being undertaken to improve service delivery. A state-widereview of organisational structures and processes in relation to the provision of hospital postnatal care in Victoria was undertaken. This paper focuses on the impact of staffing issues on the provision of quality postnatal care from the perspective of care providers.MethodsA study of care providers from Victorian public hospitals that provide maternity services was undertaken. Datawere collected in two stages. Stage one: a structured questionnaire was sent to all public hospitals in Victoria that provided postnatal care (n = 73), exploring the structure and organisation of care (e.g. staffing, routine observations, policy framework and discharge planning). Stage two: 14 maternity units were selected and invited to participate in a more in-depth exploration of postnatal care. Thirty-eight key informant interviews were undertaken with midwives (including unit managers, associate unit managers and clinical midwives) and a medical practitioner from eachselected hospital.ResultsStaffing was highlighted as a major factor impacting on the provision of quality postnatal care. There were significant issues associated with inadequate staff/patient ratios; staffing mix; patient mix; prioritisation of birth suites over postnatal units; and the use of non-permanent staff. Forty-three percent of hospitals reported having only midwives (i.e. no non-midwives) providing postnatal care. Staffing issues impact on hospitals' ability to provide continuity of care. Recruitment and retention of midwives are significant issues, particularly in rural areas.ConclusionStaffing in postnatal wards is a challenging issue, and varies with hospital locality and model of care. Staff/patient ratios and recruitment of midwives in rural areas are the two areas that appear to have the greatest negative impact on staffing adequacy and provision of quality care. Future research on postnatal care provision should include consideration of any impact on staff and staffing.
Highlights
State-wide surveys of recent mothers conducted over the past decade in Victoria, one state of Australia, have identified that women are consistently less satisfied with the care they received in hospital following birth compared with other aspects of maternity care
In SRM 2000, the factors which had the strongest associations with less positive ratings of postnatal care were those which had to do with women's experiences of specific aspects of care: the sensitivity of caregivers; extent to which anxieties and concerns were taken seriously; how rushed caregivers seemed; the helpfulness of advice and support, and whether help and advice was offered at all [1]. These findings are similar to other reports [5,6]. Given that these factors all relate to interactions between new mothers and care providers, it is important to explore the issue of staff and staffing in relation to postnatal care provision
The aim of this paper is to describe staffing and related issues in the provision of postnatal care in public hospitals in Victoria from the caregivers' perspective; and to explore what impact providers believe staffing issues have on their ability to provide high quality care to women
Summary
State-wide surveys of recent mothers conducted over the past decade in Victoria, one state of Australia, have identified that women are consistently less satisfied with the care they received in hospital following birth compared with other aspects of maternity care. In SRM 2000, the factors which had the strongest associations with less positive ratings of postnatal care were those which had to do with women's experiences of specific aspects of care: the sensitivity of caregivers; extent to which anxieties and concerns were taken seriously; how rushed caregivers seemed; the helpfulness of advice and support, and whether help and advice was offered at all [1]. These findings are similar to other reports [5,6]. Given that these factors all relate to interactions between new mothers and care providers, it is important to explore the issue of staff and staffing in relation to postnatal care provision
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