Ann Kinnear, Australian College of Midwives - Determined to Collaborate


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Ann Kinnear, Executive Officer, delivered this presentation at the 2013 Obstetric Malpractice Conference. This is the only national conference for the prevention, management and defence of obstetric negligence claims.

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Ann Kinnear, Australian College of Midwives - Determined to Collaborate

  1. 1. Determined to Collaborate Working together to provide high quality and safe maternity care Ann Kinnear
  2. 2. Discussion will include • The Determination • Collaborative Arrangements • PII for Midwives • ACM Safety and Quality Program
  3. 3. Maternity Reforms
  4. 4. National Health (Eligible Midwives) Determination 2010 “… an ‘eligible midwife’ in relation to whom an approval is in force under section 84AAF, so far as the eligible midwife provides midwifery treatment in a collaborative arrangement of a kind or kinds specified in a legislative instrument made by the Minister for the purpose of the definition of ‘authorised midwife’, with one or more medical practitioners of a kind or kinds specified in the legislative instrument.
  5. 5. Collaborative Arrangements? The Determination defines collaboration as: • being employed or engaged by a medical practice that employs or engages at least one obstetrician or medical practitioner who provides obstetric services; • receiving patients on referral from a specified medical practitioner; • having a signed agreement with a specified medical practitioner; • maintaining written records of certain specified information relating to working collaboratively with a specified medical practitioner.
  6. 6. Collaborative Arrangements? The National Guidance on Collaborative Maternity Care defines collaboration as: “… collaboration is a dynamic process of facilitating communication, trust and pathways that enable health professionals to provide safe woman- centered care. Collaborative maternity care enables women to be active participants in their care. Collaboration includes clearly defined roles and responsibilities for everyone involved in the woman’s care, especially for the person the woman sees as her maternity care coordinator.”
  7. 7. The devil is in the detail
  8. 8. Is this Collaboration?
  9. 9. Midwives Experiences • Difficult and at times impossible • Occasional individual arrangements between midwives and obstetricians • Occasional access to hospitals • Medicare items • Lack of understanding around working with eligible midwives “I have written over 100 letters seeking collaborative arrangements and even doctors I used to collaborate with well don’t want a written agreement.”
  10. 10. Admitting rights
  11. 11. Medicare items 0 2000 4000 6000 8000 10000 12000 14000 16000 18000 NSW VIC QLD SA WA TAS ACT NT Nov 2010 -April2013 all 0 50 100 150 200 250 NSW VIC QLD SA WA TAS ACT NT Nov 2010 - April 2013 Labour items
  12. 12. Determined to change? Proposed Changes • Collaborative Arrangements with Health Services and/or hospitals Barriers • Professional disagreements • Financial • Red-tape • PII for Midwives
  13. 13. Overcoming Barriers ACM Quality and Safety Program
  14. 14. Quality and Safety Program The ACM believes that all maternity care should be provided: • using evidence based guidelines • by appropriately trained and regulated health professionals • within quality and safety frameworks
  15. 15. Hot off the Press – 3rd edition • Embedded in Midwifery practice across Australia • Evidence-based • Evaluated under RCT conditions and an observational study • Government policy • Clear guidance • Appendix A – When a woman chooses care outside the guidelines • Wide midwifery and medical consultation during development
  16. 16. Characteristics of the Program 1. Competence assessment 2. Review of serious adverse events 3. Support for practitioners 4. Discipline
  17. 17. Competence Assessment • Recency of Practice ▫ Annual practicing certificate ▫ Supported reflection on practice through Midwifery Practice Review (MPR) • Continuing Professional Development ▫ Annual practicing certificate ▫ Supported professional development planning and reflection through MPR
  18. 18. Adverse event review • Safe environment for review • Learning from adverse events • Improving practice and outcomes
  19. 19. Support • Buddy system for newly practising midwives • Mentor program for midwives changing clinical setting or contexts of practice • Experienced mentor midwives (Supervision Model) • 24-hour Helpline for all midwives
  20. 20. Discipline • Responsibility of the regulator (currently NMBA) • Link with the regulator about potential disciplinary matters • Receive referrals from the regulator for support and continued development
  21. 21. ACM Quality and Safety Program Competence Assessment Clinical practice CPD Risk Management Incident review Lessons learned Support Mentor Expert clinicians 24/7 helpline Regulator Discipline Register Education Standards
  22. 22. Summary • Complex difficult scheme • Inequality • Increasing willingness to solve the problems with the scheme • Has improved access for some women • Room for improvement
  23. 23. Questions