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Postgraduate Seminar Day Presentation, 30 April 2014

Home birth and the NHS: Exploring the dynamics of institutional change mechanisms on the implementation of midwife-led models of care. Postgraduate Seminar Day Presentation, 30 April 2014

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Postgraduate Seminar Day Presentation, 30 April 2014

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  1. Home birth and the NHS: Exploring the dynamics of institutional change mechanisms on the implementation of midwife-led models of care Postgraduate Seminar Day Presentation, 30 April 2014 Student: Lisa Common BA (Hons), MA, RM Doctoral Research, Nottingham University Business School Supervisors: Professor Justin Waring, Dr Emma Rowley, Dr Melanie Jordan

  2. Who am I? • Qualified as a midwife in 2008 • Rotational hospital, core MLC, community and core labour suite and one year part-time secondment as a practitioner health lecturer. Currently working 12 hrspwcore labour suite • MA Research Methods (Health Pathway) Distinction • NIHR Studentship 2012-13 • Registered for a PhD programme with Nottingham University Business School, 2013-2016

  3. What’s My Motivation?

  4. My Research Orientation

  5. Context of home birth in UK • UK Births increasing (>800K in 2013); home birth rate falling • Home births 1927 = 85% • Home births 2012 = 2.16% • Policy • Changing Childbirth, Maternity Matters… • Evidence for safety • Birthplace in England Research Programme, Cochrane Systematic Reviews… • Cost • NHS financial crisis looking for innovative solutions • Birthplace’s cost-effectiveness analysis

  6. Sensitising Theories • Institutional Theory • Institutional Work • Deinstitutionalisation

  7. More theories! • Sociology of the Professions • The subordination of adjacent professions; restricting the occupational boundaries of other professions; exclusion by limiting access to registration and therefore legitimacy; and incorporation of the work of other professions into theirs • Social Movement Theory • Institutions do not only emerge to deliver appropriate answers to local problems, they may also arise from intensive collective struggles where efforts are combined to challenge existing institutions and propose new ones

  8. Research questions • What strategies do service leaders use to identify new institutional opportunities for change? • How are the rhetorical arguments for and against change mobilised by different stakeholders? • How do stakeholders utilise additional social networks to implement change?

  9. Methods • Qualitative • Case studies x3 • Change, some change, no change (one non-NHS) • Interviews • 25 at each case site: Mgrs, MWs, Obs, GPs, CCGs • Focus group of postnatal women where possible • Documentary Analysis • Non-participant observation of meetings

  10. Propose my contribution • Theoretical • Organisational and medical sociology questions about occupational relationships and the priorities that frame the allocation and management of health service resources • Strategic • Specific evidence for healthcare leaders interested in understanding the barriers and drivers to change • Operational • Inform conversations about increasing the plurality of choice for commissioners and providers who are striving to develop new models of care

  11. Thank you, questions please Lisa Common E: lixlmc@nottingham.ac.uk T: 07966 782 433

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