Managerial thinking in neonatal care: a qualitative study of place of care decision-making for preterm babies born at 27–31 weeks gestation in England
Objectives Preterm babies born between 27 and 31 weeks of gestation in England are usually born and cared for in either a neonatal intensive care unit or a local neonatal unit—with such units forming part of Operational Delivery Networks. As part of a national project seeking to optimise service del...
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BMJ Publishing Group
2022-06-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/6/e059428.full |
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| author | Neena Modi Elizabeth S Draper Miaoqing Yang Sarah E Seaton Kelvin Dawson Vasiliki Bountziouka Oliver Rivero-Arias Thillagavathie Pillay Natalie Armstrong Alexis Paton Elaine Boyle Victor L Banda Caroline Cupit Bradley Manktelow Abdul Qader T Ismail |
| author_facet | Neena Modi Elizabeth S Draper Miaoqing Yang Sarah E Seaton Kelvin Dawson Vasiliki Bountziouka Oliver Rivero-Arias Thillagavathie Pillay Natalie Armstrong Alexis Paton Elaine Boyle Victor L Banda Caroline Cupit Bradley Manktelow Abdul Qader T Ismail |
| author_sort | Neena Modi |
| collection | DOAJ |
| description | Objectives Preterm babies born between 27 and 31 weeks of gestation in England are usually born and cared for in either a neonatal intensive care unit or a local neonatal unit—with such units forming part of Operational Delivery Networks. As part of a national project seeking to optimise service delivery for this group of babies (OPTI-PREM), we undertook qualitative research to better understand how decisions about place of birth and care are made and operationalised.Design Qualitative analysis of ethnographic observation data in neonatal units and semi-structured interviews with neonatal staff.Setting Six neonatal units across two neonatal networks in England. Two were neonatal intensive care units and four were local neonatal units.Participants Clinical staff (n=15) working in neonatal units, and people present in neonatal units during periods of observation.Results In the context of real-world neonatal practice, with multiple (and rapidly-evolving) uncertainties relating to mothers, babies and unit/network capacity, ‘best place of care’ protocols were only one element of much more complex decision-making processes. Staff often made judgements from a less-than-ideal starting point, and were forced to respond to evolving clinical and organisational factors. In particular, we report that managerial considerations relating to demand and capacity organised decision-making; demand and capacity management was time-consuming and generated various pressures on families, and tensions between staff.Conclusions Researchers and policymakers should take account of the organisational context within which place of care decisions are made. The dominance of demand and capacity management considerations is likely to limit the impact of other improvement interventions, such as initiatives to integrate families into the neonatal care provision. Demand and capacity management is an important element of neonatal care that may be overlooked, but significantly organises how care is delivered. |
| format | Article |
| id | doaj-art-81281580cdb846e2ba9612c7e3828ac3 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-81281580cdb846e2ba9612c7e3828ac32025-01-27T15:55:09ZengBMJ Publishing GroupBMJ Open2044-60552022-06-0112610.1136/bmjopen-2021-059428Managerial thinking in neonatal care: a qualitative study of place of care decision-making for preterm babies born at 27–31 weeks gestation in EnglandNeena Modi0 1Elizabeth S Draper2Miaoqing Yang3Sarah E Seaton4Kelvin Dawson5Vasiliki Bountziouka6Oliver Rivero-Arias7Thillagavathie Pillay8Natalie Armstrong9Alexis Paton10Elaine Boyle11Victor L BandaCaroline Cupit12Bradley ManktelowAbdul Qader T Ismail5 Neonatal Medicine, Imperial College London, London, UKpharmacologistPaediatric Intensive Care Audit Network, Department of Population Health Sciences, University of Leicester, Leicester, UKNational Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK3 Department of Population Health Sciences, University of Leicester College of Life Sciences, Leicester, UK8 Research and Development, BLISS, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UKDepartment of Cardiovascular Sciences and NIHR Cardiovascular Research Centre, University of Leicester, Leicester, UK7 Nuffield Department of Population Health, University of Oxford National Perinatal Epidemiology Unit, Oxford, UKDepartment of Health Sciences, University of Leicester, Leicester, UK3 Department of Population Health Sciences, University of Leicester, Leicester, UK5 Department of Health Sciences, University of Leicester, Leicester, UK3 Neonatal Medicine, University of Leicester, Leicester, UKDepartment of Health Sciences, University of Leicester, Leicester, UKObjectives Preterm babies born between 27 and 31 weeks of gestation in England are usually born and cared for in either a neonatal intensive care unit or a local neonatal unit—with such units forming part of Operational Delivery Networks. As part of a national project seeking to optimise service delivery for this group of babies (OPTI-PREM), we undertook qualitative research to better understand how decisions about place of birth and care are made and operationalised.Design Qualitative analysis of ethnographic observation data in neonatal units and semi-structured interviews with neonatal staff.Setting Six neonatal units across two neonatal networks in England. Two were neonatal intensive care units and four were local neonatal units.Participants Clinical staff (n=15) working in neonatal units, and people present in neonatal units during periods of observation.Results In the context of real-world neonatal practice, with multiple (and rapidly-evolving) uncertainties relating to mothers, babies and unit/network capacity, ‘best place of care’ protocols were only one element of much more complex decision-making processes. Staff often made judgements from a less-than-ideal starting point, and were forced to respond to evolving clinical and organisational factors. In particular, we report that managerial considerations relating to demand and capacity organised decision-making; demand and capacity management was time-consuming and generated various pressures on families, and tensions between staff.Conclusions Researchers and policymakers should take account of the organisational context within which place of care decisions are made. The dominance of demand and capacity management considerations is likely to limit the impact of other improvement interventions, such as initiatives to integrate families into the neonatal care provision. Demand and capacity management is an important element of neonatal care that may be overlooked, but significantly organises how care is delivered.https://bmjopen.bmj.com/content/12/6/e059428.full |
| spellingShingle | Neena Modi Elizabeth S Draper Miaoqing Yang Sarah E Seaton Kelvin Dawson Vasiliki Bountziouka Oliver Rivero-Arias Thillagavathie Pillay Natalie Armstrong Alexis Paton Elaine Boyle Victor L Banda Caroline Cupit Bradley Manktelow Abdul Qader T Ismail Managerial thinking in neonatal care: a qualitative study of place of care decision-making for preterm babies born at 27–31 weeks gestation in England BMJ Open |
| title | Managerial thinking in neonatal care: a qualitative study of place of care decision-making for preterm babies born at 27–31 weeks gestation in England |
| title_full | Managerial thinking in neonatal care: a qualitative study of place of care decision-making for preterm babies born at 27–31 weeks gestation in England |
| title_fullStr | Managerial thinking in neonatal care: a qualitative study of place of care decision-making for preterm babies born at 27–31 weeks gestation in England |
| title_full_unstemmed | Managerial thinking in neonatal care: a qualitative study of place of care decision-making for preterm babies born at 27–31 weeks gestation in England |
| title_short | Managerial thinking in neonatal care: a qualitative study of place of care decision-making for preterm babies born at 27–31 weeks gestation in England |
| title_sort | managerial thinking in neonatal care a qualitative study of place of care decision making for preterm babies born at 27 31 weeks gestation in england |
| url | https://bmjopen.bmj.com/content/12/6/e059428.full |
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