Creating a Collaborative Culture in Maternity Care

Soo Downe, RM, MSc, PhD; Kenny Finlayson, BSc; Anita Fleming, RM, RN, MA

J Midwifery Womens Health. 2010;55(3):250-254.

Abstract and Introduction

Abstract

Effective collaboration between professional groups is increasingly seen as an essential element in good quality and safe health care. This is especially important in the context of maternity care, where most women have straightforward labour and birth experiences, but some require rapid transfer between care providers and settings. This article presents current accounts of collaboration—or lack of it—in maternity care in the United Kingdom, United States, and Australia. It then examines tools designed to measure collaboration and teamwork within general health care contexts. Finally, a set of characteristics are proposed for effective collaboration in maternity care, as a basis for further empirical work in this area.

Introduction

The issue of collaboration is high on the health care agenda in many countries. In maternity care, collaboration is seen as particularly important for pregnant women who cross boundaries, from low- to high-risk status (or vice versa) or from one geographic place of birth to another. It is at these boundary points that differing philosophies of care may lead to miscommunication, tension, or even antagonism. Resolving these issues might not only benefit women at higher risk of adverse outcome, but also facilitate the normalisation of childbirth for the majority of women. If women and their partners are to feel confident about the birth choices they make, then a collaborative climate is needed, in which the views of all those involved in maternity care are acknowledged and respected. To date, there has been very little discussion about the nature of collaboration or of the efficacy of various collaborative models.

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Box 1. National Health Service Leadership Qualities Framework: Collaborative Working ^[20]
0 Goes it alone Fails to involve others in bringing about integrated health care Does not share information with other stakeholders. 1 Appreciates others' views Expresses positive expectations of internal and external stakeholders Acknowledges and respects others' diverse perspectives 2 Works for shared understanding Shares information with partners when appropriate Summarises progress, taking account of differing viewpoints, so as to clarify understanding and to establish common ground Surfaces conflict and supports resolution of this conflict 3 Forges partnerships for the long term Maintains positive expectations of other stakeholders, even when provoked, and strives to create the conditions for successful partnership working in the long term Is informed on the current priorities of partners and responds appropriately to changes in their status or circumstances Ensures that the strategy for health improvement is developed in a cohesive and "joined up" manner

Box 2. Possible Characteristics of Effective Collaboration
Contextual components Clear and respected boundaries Effective systems for conflict resolution Opportunities for participation and for building cohesion Acceptance of open and honest communication Mutual trust Acknowledgement of interdependence Acceptance of shared responsibilities Influencing factors Supportive organizational structure Availability of resources (including time) A history of collaboration Positive individual attitude

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