From relatively small initiatives in midwifery care, such as changes in shift rotas or new systems in record keeping, to major changes such as the introduction of midwifery-led beds or the "Team approach" continuous change has become an inherent part of professional lives. Whether it is liked or not, to some degree its ramifications affect every midwife and nurse, and the need to become acquainted and comfortable with change is vitally important for our professional progress With the introduction of Changing Childbirth Department of Health, (1993) which stressed informed choice for women and their partners, women centered care and more importantly continuity of care and carer, it is important that midwives have a "well person" mentality, ready to argue evidence-based practice and be true autonomous practitioners.
[...] Midwifery supervision with its primary function of protecting the public from unsafe practice cannot be separated from risk management and the supervisor has an important role in developing and implementing guidelines for practice. The roots of risk management strategies adopted by trusts lie in insurance primarily to reduce the incidence of compensation claims. Supervision makes an important contribution to risk management, quality and audit strategies, as well as multi-professional development of protocols and guidelines for practice Kirkham, (1996). Effective communication is another important factor in effective change. [...]
[...] The advantages in working through this particular change strategy is that it involves all grades of staff from the ‘shop floor' gradually filtering through the rest of the organization rather than the reverse i.e. traditional change that was mentioned earlier. Current examples of the application of the normative-re-educative strategy for change are the moves towards a more patient-centered approach to care and education. The active involvement of the woman in identifying needs and selecting outcomes to achieve the desired outcomes of the plan of care and in evaluating the effectiveness of the care is another example of the bottom up approach to change Keyzer, (1985); Wright, (1986); Pearson, (1989). [...]
[...] In the dynamic world of midwifery today, and in moving the change forward, there needs to be a steering force or a change agent. Wright (1998). Ottaway (1976, 1980) identifies a change strategy that can be incorporated in Lewin's model where one works from the bottom up (normative-re-educative approach) see Appendix 1. This approach is demonstrated by Winterton (1992), with women and midwives calling upon those in authority, such as obstetricians and government to support and focus on changes needed in the provision of care. [...]
[...] This may be viewed as the collection and the interpretation of information, by formal or informal means, to aid defensible decision making. New patterns of care should be designed to allow evaluation of both their effectiveness and their acceptability to women using the service. DOH (1993). An effective way of evaluating the change process could be achieved through delivering quality in practice and education and observing the effects. Quality is easy to understand, as it is one of the everyday needs. Everyone needs quality. Pirsig (1974) pp famously defined quality as what you like. [...]
[...] (1998) Managing Change: The essentials of nursing management 2nd.Edition. Macmillan Press LTD London. Bucknall Robertson Moran Stevenson R 1992. Improving management of asthma: closing the loop or progressing along the audit spiral? Health Care 1:15 Buckley E R 1997 Delivering quality in midwifery Bailliere Tindall, London, pp. 33-61. Cross R E (1996) Midwives and Management: A handbook for midwives. Books for midwives press LTH. Cheshire Dineen, M. (1997). Clinical risk management and midwives. Modern Midwife Vol No pp. 9-13 Department of Health Winterton report. [...]
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