Change In Healthcare Organizations Research Articles

Enabling successful change in a high-demand working environment: a case study in a health care organization

PurposeThe anticipation of organizational change and the transition process often creates uncertainty for employees and can lead to stress and anxiety. It is therefore essential for all organizations, especially those that operate in high-demand working environments, to support the well-being of staff throughout the change process.Design/methodology/approachResearch on how employees respond to the organizational change of relocating to a new work space is limited. To fill this gap in the research, we present a case study examining the well-being of clinical and health care employees before and after a disruptive change: relocation in workplace facilities. In addition, factors that enabled successful change in this high-stress, high-demand working environment were investigated. Interviews were conducted with 20 participants before the relocation and 11 participants after relocation. Following an inductive approach, data were analyzed using thematic analysis to identify key themes.FindingsOur findings suggest that a supportive team, inclusive leadership and a psychologically safe environment, may buffer negative employee well-being outcomes during disruptive organizational change.Originality/valueThis research contributes to the literature on successful organizational change in health care by highlighting the resources which support well-being throughout the change process and enabling the successful transition to a new facility.

Uticaj liderskih osobina menadžera na ključne pokazatelje aktivnosti hirurških klinika

Human resources reform is the main driver of improvement and change in healthcare organizations and the healthcare system in general. Thorough transformation of management and improvements in the structure and quality of employee performance are necessary for progress in the healthcare sector. This need for change stems from an increasing awareness of the importance of strategic human resources planning in healthcare, as well as the necessity of providing better quality services despite limited financial resources. Leadership skills are recognized as key to success in healthcare and can be adopted through targeted work and development, which benefits not only institutions but also individuals on a personal level. The World Health Organization (WHO) emphasizes the importance of capacity building in leadership and management, proposing a model that balances between four interconnected segments. This model should be adapted to local specificities, so that it would be as efficient as possible. The specific objective of this research was to analyse the leadership qualities of heads of surgical clinics of the University Clinical Centre in Niš (UCC Niš), based on employee ratings, and to explore how these qualities affect the key indicators of success of these clinics. The research consisted of two parts: qualitative, which included an analysis of the tertiary level healthcare institution during the period from June 2010 to March 2017, and quantitative, in which data on the activities and the quality of operation of surgical clinics were collected and analysed. Research results indicate a generally high leadership abilities rating among surgical clinic managers, noting that building trust among employees has been identified as an area with room for improvement. The highest ratings were assigned to managers' qualities related to goal-orientation and perseverance in their achievement, regardless of the circumstances. The study also shows that leadership qualities have a significant impact on key performance indicators of surgical clinics, confirming the importance of developing effective leadership in the healthcare sector.

Violence against healthcare workers during the COVID-19 pandemic: a cross-sectional survey at Cairo University Hospital.

Healthcare workers have a significant chance of experiencing violence, with physical violence impacting anywhere from 8 to 38% of healthcare professionals throughout their careers. Besides physical abuse, many healthcare workers are subject to verbal aggression or threats, with patients and visitors being the most frequent sources of such incidents. This research examines the work atmosphere of healthcare professionals at Kasr Al-Aini University Hospital in Cairo, Egypt, during the pandemic. The study aims to evaluate the frequency of violence toward healthcare workers and health professionals training through a cross-sectional survey conducted among them. The research was conducted on Egyptian healthcare workers over 6 months, from November 2020 until the end of January 2021, using convenience sampling in a cross-sectional study. Over half of the respondents reported experiencing violence. Among those who experienced violence, 93% reported verbal aggression, 43% reported physical and verbal abuse, and 59% claimed that violence increased during the pandemic. Additionally, 97% of those who experienced violence reported it occurring within the 4 months following the survey. About 42.5% of the respondents were female, and nearly 65% were over 30. 82% of the respondents did not receive training on handling violence while performing their job. This study highlights the high prevalence of verbal assaults in healthcare settings, primarily by patients' families or acquaintances. Despite reporting such incidents, most respondents did not see any significant government action. Furthermore, the COVID-19 pandemic did not significantly change the frequency of violent incidents, indicating that the root causes of violence are systemic and extend beyond the pandemic. These findings underscore the need for systemic changes in healthcare organizations to address and prevent violence against healthcare workers.

Using FOCUS-PDSA Quality Improvement Methodology Model in Healthcare: Process and Outcomes.

Using FOCUS-PDSA Quality Improvement Methodology Model in Healthcare: Process and Outcomes.

The Balancing Act of Clinical Leadership: Lessons Learned from the COVID-19 Pandemic

The COVID-19 pandemic disrupted the world of leadership. Every healthcare professional—front-line staff and leaders alike—adapted their work to confront this virus. The contributions of clinical leaders during the COVID-19 pandemic are unique and important. Experiences of clinical leadership reinforce the critical nature of leadership strategy, quality improvement principles, and commitment to integrated, whole-system quality. Clinical leaders, possessing the dual responsibility of front-line care and system-level leadership, hold critical insights regarding change in healthcare organizations as a whole. In their pandemic response, clinical leaders demonstrated key leadership characteristics that required individual growth and facilitated team cohesion: communicating with consistency and humanity; being the first to try; attending to burnout and moral injury; and building bridges to strengthen the overall response. John Kotter’s landmark book, Leading Change, provides an anchoring framework for examining the experiences and strategies of clinical leaders during the COVID-19 pandemic.

Reforming healthcare in the Netherlands: practical population health management and the Plot model: A questionnaire survey and focus group study to assess the willingness and readiness of six regions in the Netherlands.

As in many other countries, the Netherlands is facing challenges in the provision of healthcare to its population. To ensure the population remains in good health in coming decades, an integrative approach to the many factors that influence health and health outcomes is needed. Population health management is gaining interest as a strategic framework for systems change in healthcare organisations. Based on population health management, the Dutch HealthKIC has developed the 'Plot model', which takes a regional perspective. The aim of this study was to detail the extent to which six prospective regions in the Netherlands were ready and willing to implement population health management using the Plot model, guided by the Five Lenses Model. Using an exploratory focus group reporting study, we involved stakeholders from six regions in the Netherlands. Thematic analysis followed the five predesigned dimensions of a validated cooperation model. The study uncovered the potential for realisation of model aims, as assessed by an expert team, regarding shared ambition, mutual gains, relationship dynamics, organisational dynamics and process management. The exploratory questionnaire suggested that organisational dynamics is the least integrated topic in all areas, followed by process management, a finding confirmed in focus groups. The building themes of the Five Lenses Model all represent preconditions for the success of integration in the prospective regions. The present study showed that while some themes were reasonably represented in prospective regions, no region was satisfactory for all themes.

Faculty development participants' experiences of working with change in clinical settings.

Many universities offer faculty development to support teachers in developing and improving clinical education in the health professions. Although research shows outcomes on individual levels after faculty development, little is known about its contribution to change within the organisation. To advance current faculty development and ensure that it can support wider educational change in healthcare organisations, a better understanding of educational change practices in these settings is needed. This study therefore explores the experiences of working with educational change in clinical workplaces from the perspective of clinical educators that have undergone faculty development training. The study adopts perspectives on change as influenced by context to include the impact from clinical workplaces on individuals' change work. A collective case study design with a multi-institutional approach was applied and individual interviews with 14 clinical educators from two universities, one in Sweden and one in South Africa, were conducted. Data were analysed separately before a cross-case analysis was performed, synthesising the findings from both sites. Participants shared experiences of having limited opportunities to work with educational change beyond their own individual teaching practices within their clinical workplaces. Also, participants appeared to refrain from leading change and rather pursued change on their own or relied on indirect approaches to change. They described several workplace aspects influencing their work, including the organisation and management of teaching, the resources and incentives for teaching and the attitudes and beliefs about teaching within the clinical community. The study shows that clinical educators are part of communities and contexts that shape their approaches to educational change and influence which changes are feasible and which ones are not. It thus adds to the understanding of change as contextual and dynamic and contributes with implications for how to advance faculty development to better support change in practice.

De impact van Covid-19 op chronische zorg volgens zorgverleners: een kwalitatieve studie bij eerstelijnspraktijken in België

The impact of COVID-19 on chronic care according to providers: a qualitative study among primary care practices in Belgium The COVID-19 pandemic affects the processes of routine care for chronic patients. A better understanding helps to increase the resilience of the health system and to prepare it adequately for next waves of the pandemic. A qualitative study was conducted in 16 primary care practices: 6 solo working, 4 monodisciplinary and 7 multidisciplinary. Using semi-structured video interviews, 21 people (doctors, nurses, dieticians) were interrogated. A thematic analysis was performed using the domains of the chronic care model (CCM). Three themes emerged: changes in health care organization, risk stratification and self-management support. All participating practices reported drastic changes in organization with a collective shift towards COVID-19 care and a reduction of chronic care activities, less consultations, and staff responsible for self-management support put on hold. A transition to digital support did not occur. Few practitioners had a systematic approach to identify and contact high-risk patients for early follow-up. A practice with a pre-established structured team collaboration managed to continue most chronic care elements. Generally, practitioners expected no effects of the temporary disruption for patients, although they expressed concern about patients already poorly regulated. The findings in this article show a disruption of the delivery of chronic care in the Belgian primary care context. In such contexts, the establishment of the CCM can facilitate the continuity of care in times of a crisis. Short-term actions should be directed to facilitate the identification of high-risk patients and to develop a practice organization plan to organize chronic care and to use digital channels for support, especially with regard to vulnerable patients, during next waves of the epidemic.

CHANGES IN THE DEMOGRAPHIC AND CLINICAL FEATURES OF COLORECTAL CARCINOMA CASES FOLLOWING THE COVID-19 PANDEMIC

Amaç
 Bu çalışma, Covid-19 pandemisinden önce ve sonra
 başvuran kolorektal karsinomlu hastaların demografik,
 klinik ve patolojik özelliklerini karşılaştırmayı
 amaçladı.
 Gereç ve Yöntem
 Pandemiden 9 ay önce ve ilk 9 ay içinde başvuran
 olgular çalışmaya dahil edildi. Bu çalışmanın birincil
 sonuç ölçütü, iki dönem boyunca invaziv kolorektal
 karsinomlu hastaların klinik ve patolojik özelliklerindeki
 farklılıktı.
 Bulgular
 Pandemi öncesi ve pandemi sonrası hastalar yaş,
 cinsiyet, tümör yerleşimi, tümör boyutu, lenf nodu invazyonu,
 farklılaşma, senkron tümör varlığı, radyal
 ve distal cerrahi sınır pozitifliği, perinöral ve lenfovasküler
 invazyon, TNM evresi, karaciğer metastazı ve
 nüks bakımından benzerdi. Pandemi öncesi döneme
 göre fark istatistiksel olarak anlamlı olmasa da, pandemi
 sonrası hastalarda ileuslu 3 hasta (%4,7) ve tümör
 perforasyonu olan 2 hasta (%3,2) belirledik.
 Sonuç: Bulgularımız, pandemi sonrası dönemde
 kolorektal karsinom nedeniyle ameliyat olan hasta
 sayısında, muhtemelen hastanelerdeki sağlık organizasyonundaki
 yapısal değişiklikler ve hastaların
 SARS-CoV-2 ile olası enfeksiyon nedeniyle sağlık
 hizmetine başvuruda tereddüt etmesi nedeniyle pandemi
 öncesi döneme göre hafif bir azalma olduğunu
 göstermektedir. Sağlık sistemlerinin, Covid-19 salgını
 sırasında maligniteler gibi ciddi klinik durumları yönetmenin
 yeni yollarını bulmaya çalışması gerektiği
 açıktır.

Multiple criteria decision analysis for therapeutic innovations in a hemophilia care center: A pilot study of the organizational impact of innovation in hemophilia care management.

Several innovative drugs liable to lead to changes in healthcare organization are or soon will be available for the management of hemophilia. Analyzing their implementation can shed further light on healthcare decision-making, to anticipate changes and risk of breakdown in the patient's care pathway. Multiple criteria decision analysis (MCDA), based on ISPOR recommendations, was used to assess the organizational impact of innovation in hemophilia care management. The MCDA process designed for this specific context involved ten French experts in hemophilia care management (physicians, nurses, pharmacist, physiotherapist and psychologist) in the hemophilia care center of Chambéry, in the Rhône-Alpes Region of France. This pilot study involved seven steps: (i) defining the decision problem; (ii) selecting and structuring criteria; (iii) assessing the relative weight of each criterion with software-assisted simulation based on pairwise comparisons of different organizational change scenarios; (iv) measuring the performance of the selected innovations; (v) scoring alternatives; (vi) calculating aggregate scores; (vii) discussion. The endpoint was to determine the expected overall organizational impact on a 0-100 scale. Seven organizational criteria were selected. "Acceptability for patient/caregiver/association" was the most heavily weighted. Factor VIII by subcutaneous route obtained the highest aggregate score: i.e., low impact on care organization (88.8 out of 100). The innovation with strongest organizational impact was gene therapy (27.3 out of 100). This approach provided a useful support for discussion, integrating organizational aspects in the treatment decision-making process, at healthcare team level. The study needs repeating in a few years' time and in other hemophilia centers.

Implementation of Smartphone Systems to Improve Quality of Life for People With Substance Use Disorder: Interim Report on a Randomized Controlled Trial.

BackgroundResearchers have conducted numerous studies seeking to understand how to improve the implementation of changes in health care organizations, but less focus has been given to applying lessons already learned from implementation science. Finding innovative ways to apply these findings efficiently and consistently will improve current research on implementation strategies and allow organizations utilizing these techniques to make changes more effectively.ObjectiveThis research aims to compare a practical implementation approach that uses principles from prior implementation studies to more traditional ways of implementing change.MethodsA total of 43 addiction treatment sites in Iowa were randomly assigned to 2 different implementation strategies in a randomized comparative effectiveness trial studying the implementation of an eHealth substance use disorder treatment technology. One strategy used an adaptation of the Network for the Improvement of Addiction Treatment (NIATx) improvement approach, while the other used a traditional product training model. This paper discusses lessons learned about implementation.ResultsThis midterm report indicates that use of the NIATx approach appears to be leading to improved outcomes on several measures, including initial and sustained use of new technology by both counselors and patients. Additionally, this research indicates that seamlessly integrating organizational changes into existing workflows and using coaching to overcome hurdles and assess progress are important to improve implementation projects.ConclusionsAt this interim point in the study, it appears that the use of the NIATx improvement process leads to better outcomes in implementation of changes within health care organizations. Moreover, some strategies used in this improvement process are particularly useful and should be drawn on more heavily in future implementation efforts.Trial RegistrationClinicalTrials.gov NCT03954184; https://clinicaltrials.gov/ct2/show/NCT03954184

The Perioperative Steering Committee as an Accountable Infrastructure to Enable and Sustain Change.

Leaders in perioperative and interventional procedure areas need to be able to initiate and sustain change to improve operational processes in their departments or service lines. Although available literature discusses change in health care organizations, there is a lack of published articles on the implementation and sustainment of change. This article provides a review of supporting literature on change management and an infrastructure model that we have successfully implemented to sustain change. An organizational case study focused on creating sustained improvements for first procedure on-time starts and turnover times details the process of creating the accountability system for actualizing the performance targets in a perioperative environment. The case study examines the existing process and initial challenges with creating sustainable and quantifiable outcomes, describes the process of implementing the infrastructure discussed in the article, and evaluates the results. Perioperative leaders can use the information to improve processes in their work environments.

Formulary management guiding principles for automated systems.

Structural and financial changes in US healthcare are the driving forces reshaping care delivery and the technologies that clinicians use in their practice. Structural-level changes in healthcare organizations bringing facilities varying in size, systems, and complexity under the new integrated care delivery networks create unprecedented challenges. This paper develops guiding principles for formulary management in automated systems that facilitate medication management and alignment of medication information technology (IT) solutions in healthcare organizations ranging in size from a single facility to very large enterprise/multifacility networks. This paper describes formulary management best practices for healthcare organizations as they follow crucial medication management processes: formulary item builds, urgent and nonformulary medication requests, and formulary item build testing and maintenance. As medication management practices are embedded in automated technologies that are similar yet nuanced, we pay special attention to practices and change control processes that maximize coordination among systems while preserving medication data integrity and reducing medication errors. For increasingly complex healthcare systems with multiple medication management system demands, formulary drug database builds and maintenance are challenging and time-consuming. Formulary item build, testing, and maintenance processes involve multifunctional teams collaborating to ensure the integrity of data, prevent unexpected system incompatibilities, and improve patient safety by reducing medication errors. Ideally, formulary item build, testing, and maintenance processes produce consistent final drug records in IT systems meeting user needs.

The Effect of Network-Level Payment Models on Care Network Performance: A Scoping Review of the Empirical Literature.

Introduction:Traditional payment models reward volume rather than value. Moving away from reimbursing separate providers to network-level reimbursement is assumed to support structural changes in health care organizations that are necessary to improve patient care. This scoping review evaluates the performance of care networks that have adopted network-level payment models.Methods:A scoping review of the empirical literature was conducted according to the five-step York framework. We identified indicators of performance, categorized them in four categories (quality, utilization, spending and other consequences) and scored whether performance increased, decreased, or remained stable due to the payment model.Results:The 76 included studies investigated network-level capitation, disease-based bundled payments, pay-for-performance and blended global payments. The majority of studies stem from the USA. Studies generally concluded that performance in terms of quality and utilization increased or remained stable. Most payment models were associated with improved spending performance. Overall, our review shows that network-level payment models are moderately successful in improving network performance.Discussion/conclusion:As health care networks are increasingly common, it seems fruitful to continue experimenting with reimbursement models for health care networks. It is also important to broaden the scope to not only scrutinize outcomes, but also the contexts and mechanisms that lead to certain outcomes.

Patient participation in care after hip fracture surgery: A systematic review

Introduction: Hip fractures constitute a painful and unpleasant situation which is more common in the elderly population. The relevant literature revealed that the management of the care of patients with hip fracture remains a major concern for the global scientific community, as it is related with a variety of socio-economic and psychosocial consequences. The purpose of this systematic review was the investigation of patient participation in their care after a hip fracture surgery. Methods: The search strategy of the literature was conducted in the data bases Pubmed/Medline, Scopus, Science Direct and Google Scholar. Results: The main issues the patients faced and prohibit their participation in the rehabilitation phase were pain, fear of a new fall, postoperative complications, negative emotions, ineffective cooperation with staff, unrealistic expectations and difficulty in accessing a physiotherapist. On the contrary, positive attitude and support of the health professionals, community care services, adequate information, positive patient disposition, daily exercise and access to a physiotherapist were factors that facilitated the care rehabilitation, as well as the process of their participation. Conclusions: Emphasis should be placed on active involvement of the patients in their care, as there is evidence that it is correlated with a positive effect on health outcomes during rehabilitation. These findings could be used to encourage greater participation according to patients’ preferences and needs, while highlight the need for changes in health care organizations and for further research.

A Cross Sectional Study to Identify the Factors Influence Implementation of Changes in Healthcare Organization

A Cross Sectional Study to Identify the Factors Influence Implementation of Changes in Healthcare Organization

Nursing Communication Bundle: Behavior Standards

Changing healthcare delivery systems demand greater accountability from hospital organizations and healthcare providers (Briggs et al., 2018). The radical restructuring of the healthcare system that is required to reduce spiraling healthcare costs and make healthcare accessible to all citizens will necessitate ongoing changes in healthcare organizations. The challenge for hospital organizations is to improve quality and service delivery through an ongoing process of innovation, restructuring of systems and processes, and implementation of aligned service behaviors to increase patient satisfaction and enhance clinical outcomes (Figure 1.0). Patient satisfaction scores serve as system indicators for financial reimbursement from government and private insurance agencies and as impetus for hospital organizations to choose the functional system of delivering care to improve quality, achieve desired outcomes, and enhance the patient care experience. Given the macroeconomic nature of the impact of patient satisfaction scores on hospital reimbursement, the challenge for healthcare organizations is to improve quality and service delivery through an ongoing process of innovation, restructuring systems and processes, and implementation of aligned standardized service behaviors to increase patient satisfaction and enhance clinical outcomes. Hospitals under the current healthcare landscape are rewarded for the quality of care provided; thus, better outcomes indicate hospitals’ financial viability (Centers for Medicare and Medicaid Services, 2018).Managing service delivery across a highly divergent and fast-paced healthcare system requires sharp focus on execution and standardized operational excellence. Continuous quality improvement (CQI) has been shown to be a powerful tool to help make health care organizations more effective. CQI is a structured system for creating organization-wide participation and partnership in planning and implementing continuous improvement methods to understand, meet, or exceed patient needs and expectations. Developing a culture of excellence and quality in care can create an enthusiasm for change, passion for results, and drive for innovation equating to better service to healthcare consumers and better patient satisfaction scores.

Understanding implementation science from the standpoint of health organisation and management: an interdisciplinary exploration of selected theories, models and frameworks

PurposeAs a discipline, health organisation and management is focused on health-specific, collective behaviours and activities, whose empirical and theoretical scholarship remains under-utilised in the field of implementation science. This under-engagement between fields potentially constrains the understanding of mechanisms influencing the implementation of evidence-based innovations in health care. The aim of this viewpoint article is to examine how a selection of theories, models and frameworks (theoretical approaches) have been applied to better understand phenomena at the micro, meso and macro systems levels for the implementation of health care innovations. The purpose of which is to illustrate the potential applicability and complementarity of embedding health organisation and management scholarship within the study of implementation science.Design/methodology/approachThe authors begin by introducing the two fields, before exploring how exemplary theories, models and frameworks have been applied to study the implementation of innovations in the health organisation and management literature. In this viewpoint article, the authors briefly reviewed a targeted collection of articles published in the Journal of Health Organization and Management (as a proxy for the broader literature) and identified the theories, models and frameworks they applied in implementation studies. The authors then present a more detailed exploration of three interdisciplinary theories and how they were applied across three different levels of health systems: normalization process theory (NPT) at the micro individual and interpersonal level; institutional logics at the meso organisational level; and complexity theory at the macro policy level. These examples are used to illustrate practical considerations when implementing change in health care organisations that can and have been used across various levels of the health system beyond these presented examples.FindingsWithin the Journal of Health Organization and Management, the authors identified 31 implementation articles, utilising 34 theories, models or frameworks published in the last five years. As an example of how theories, models and frameworks can be applied at the micro individual and interpersonal levels, behavioural theories originating from psychology and sociology (e.g. NPT) were used to guide the selection of appropriate implementation strategies or explain implementation outcomes based on identified barriers and enablers to implementing innovations of interest. Projects aiming to implement change at the meso organisational level can learn from the application of theories such as institutional logics, which help elucidate how relationships at the macro and micro-level have a powerful influence on successful or unsuccessful organisational action. At the macro policy level, complexity theory represented a promising direction for implementation science by considering health care organisations as complex adaptive systems.Originality/valueThis paper illustrates the utility of a range of theories, models and frameworks for implementation science, from a health organisation and management standpoint. The authors’ viewpoint article suggests that increased crossovers could contribute to strengthening both disciplines and our understanding of how to support the implementation of evidence-based innovations in health care.

Functioning of Health Care During the COVID-19 Pandemic – Review of Literature

Purpose: A review of the literature on reorganization of the health care system in selected medical specializations during the COVID-19 pandemic. Design/methodology/approach: A review and analysis of available scientific literature from ScienceDirect, Google Scholar, PubMed and other scientific sources, and data analysis using Microsoft Excel. Articles were found using specific keywords, then they were assessed in detail against the criteria set by the authors Findings: The COVID-19 pandemic caused many organizational changes in health care. As a result of activities limiting the spread of COVID-19 in medical facilities, the following were observed: increased use of telemedicine to contact medical staff, limited access to physicians of various specialties, delayed diagnosis and treatment in many fields of medicine and also increased financial investment in the health care. Additionally, the pandemic reduced social contacts. It is forecast that after the pandemic, there will be an increase in demand for medical consultations due to undiagnosed and untreated patients during the pandemic. Research limitations/implications: A lack of scientific study with long-term data, a survey on a small group of respondents, studies from countries with different degrees of development (a more difficult comparative analysis), discrepancy of data in some studies due to insufficient research on the new virus – SARS-CoV-2. Originality/value: The work collects data from various medical disciplines and presents the possible impact of reorganization on the post-pandemic situation. The article is original because of the combination of medical and management aspects of the health care organization during the pandemic.

Faktor Organisasi yang Mempengaruhi Pelaksanaan Audit Maternal

Maternal audits are part of a change in health care organizations. However, complicated and rigid bureaucracy resulting in difficulties for the organization to accept change without clear and convincing scientific evidence. The maternal mortality remains high, indicating that the maternal audit is not optimal. Often audit recommendations are not implemented so that the expected changes do not occur. This study aims to find suboptimal organizational aspects in the implementation of audits to encourage all parties to collaborate in sustainable, targeted and planned changes. This is a qualitative research with a narrative review approach using secondary data from the previous seven articles. Articles were analyzed to find various obstacles and constraints on maternal audit, and then categorized based on the context of organizational behavior, namely individual, group and structure. This study identified complexities in maternal auditing, interrelated between individual, group and structural aspects, including problems of persecution, low cooperative behavior, and political policies. Those have a major impact on efforts to reduce maternal mortality. Therefore, it requires clinical and non-clinical interventions, as well as political, in accelerating the reduction of maternal mortality. The arrangement of policies, analysis processes, and follow-up on maternal audits must involve every element of the organization, both individuals and groups, in the organizational structure.