Postnatal care (PNC) has traditionally been provided to all women by midwives, health visitors and GPs. However there are two key drivers for change: the need to maximise health gain for women and children since women consistently report that postnatal care does not meet their needs; the reductions in UK health organisations’ budgets and the need to improve efficiency without adversely affecting quality of health care. This project, jointly funded by the Royal College of Midwives, NHS Scotland and ESRC is examining current practice and alternative systems of postnatal care. The study involves researchers with midwifery experience and also those with systems and modelling expertise, and staff from various collaborating NHS sites.
The particular contributions of systems and modelling include:
Systematic pathway mapping using hierarchical, computer-based models with standardised symbols and layout, combining both critical detail and high level views of the care system and its interactions. This provides a means of comparing practice with graphical models that encourage stakeholder participation in questioning current practice and identifying options for improvement.
Simulation of pathway maps to explore the logistics of proposed improvements, assessing the resource implications of each option, such as the staff-mix. Simulation can help ensure that the plan achieves a good balance between the service level and resource utilisation.
Resource allocation and routing, which can be particularly important in delivering postnatal care in the community. It is important to maintain quality, as in continuity of care, while also increasing efficiency by reducing travelling time.
Option appraisal using a combination of economic evaluation and multi-criteria decision analysis (MCDA) providing a basis for a structured comparison of the efficiency and effectiveness of the options.