John Heider The Tao Of Leadership Humanics 1986

1. John Heider The Tao Of Leadership Humanics 1986

2. Oakwood Midwifery Group6 Midwives • The Oakwood Midwifery Group Practice has been offering care to the women belonging to the Forest Hill General Practice Surgery since 1999, working alongside 9 GPs. • The demographics of the women are not wholly representative of the hospital but, in general, reflect a more affluent area covering Forest Hill and East Dulwich in South-East London. • The Midwifery Group developed from the strongly held beliefs of six midwives that caseload midwifery offered them the opportunity to work with a select group of likeminded colleagues to deliver an agreed philosophy of women-centred midwifery-led care. • This innovative way of working drew inspiration from the BUMPS team in Leicester and the One-to-One Team in West London as well as the two established group practices already functioning, in their own ways at King’s College Hospital.

3. Oakwood Midwifery Group6 Midwives • The group was originally split into three primary sub-team midwife partnerships but to effectively deal with staff turnover and level of experience is now split into two primary sub-team partnerships. • Each midwife has a caseload of 3 women per month equalling 36 women per year, for whom she is the primary midwife. In turn she acts as the second midwife for her partners’ women with whom she will share some of the care. • The group work according to a four-week roster, which allows the midwife to have defined working hours and planned days off, helping in the life-work balance. • The women can contact the midwife 24 hours a day by a pager system. When not on call, the pager is forwarded to one of the paired partners on duty. • There are guidelines on when to contact for information, support and arranging appointments; these being mainly during normal office hours. This is an important aspect of developing boundaries within the relationship and maintaining the work-life balance for the midwife. • Similarly, mobile phones are set to withhold the midwife’s number to ensure the boundary between professional and personal life as well as ensuring the women are always directed to an on-duty midwife through the pager system.

4. Oakwood Midwifery Group6 Midwives • Aside from GP referrals, the women can refer themselves directly to the midwife at an early pregnancy clinic where they will be allocated a named midwife. • The aspects of care are discussed and then agreed between woman and midwife with the ongoing care primarily taking place in the woman’s home. • The midwife offers information, encouraging the woman to make fully informed choices throughout her care and not to accept the ‘routine’ without question. The advocate role is a fundamental part in relationship. • The philosophy, that birth is a normal sociological and physiological event, is emphasised and indeed presumed until shown to be otherwise. The ethos is to trust the woman’s knowledge about her body and respect her autonomy. • At 36 weeks a birthtalk will take place where the choices for birth will be discussed and a preferred birthplan agreed. This is an hour-long appointment with two of the partnered midwives and the woman with her birth partner(s) at her home.

5. Oakwood Midwifery Group6 Midwives • When the woman believes she is in labour she can page the midwife. She is then assessed at home and care can be delivered as appropriate from this assessment. • Unless the woman appears to be in established labour, the group believes it is appropriate to leave the woman and avoid any early, unnecessary internal examination which may create a clinical path • This practice is based on the midwife’s confidence to empower and facilitate rather than control the process as outlined in the opening quote and it often takes time to install this level of confidence in a new group midwife. • As each midwife comes prepared for a homebirth, the woman can opt to stay at home even at this point. A second midwife will also attend for a homebirth, normally at second stage or earlier if support is needed. • The group’s homebirth rate is 30 - 40%. • If the hospital is to be the place of birth the midwife will follow her woman in for the birth.

6. Oakwood Midwifery Group6 Midwives • The postnatal care can follow the standard protocol guidelines but is adapted to be appropriate to the woman and her families needs. • The easy contact to her midwife through the pager system for support facilitates independence and options such as early discharge from the hospital. • Two of the midwives have been trained to undertake full baby checks, eliminating the need for checks by hospital paediatrician or GP, extending the continuity of care. • The postnatal care may continue up to 28 days before full discharge.

7. Oakwood Midwifery Group6 Midwives • The main advantages, to the midwife, of this way of working, are the increased level of autonomy and accountability in a supportive environment, which fosters individual development. • This way of working also has an increased level of job satisfaction. • The pairing of midwives who share a caseload and the predefined shift pattern reduce the element of burnout, which is often associated with caseload midwifery. • Working within the Oakwood Midwifery Group has also given us the opportunity to share in the joy of this experience with women. • See http://www.guardian.co.uk/society/2007/may/18/health.medicineandhealth1

8. Three Team Roster3 x 2 Midwives

9. Two Team Roster2 x 3 Midwives

10. Oakwood Midwifery GroupFakta og tal • Etableret 1999 baseret i en læge praksis med 9 praktiserende læger • Gruppen acceptere kvinder uden henvisning fra praktiserende læge og kan tilbyde fuldbyrdigt baby check, så hele forløbet kan holdes helt udenfor sygehus og medicinsk sammenhæng, så længe behov og forløb dikterer det muligt • Konsultation, fødselssamtale og barsels besøg i hjemmet, med op til 28 dages barselspleje efter behov • 3 kvinder per jordemoder per måned; 36 kvinder per år per jordemoder svarende til WHO’s optimale guidelines • 2 jordemødre til hjemmefødsler, 1 jordemoder til hospitalsfødsler • Mobil telefon, personsøger og hjemmefødselsudstyr for hver jordemoder, inklusiv ilt og lattergas • 30 - 40% hjemmefødsler • Fire ugers vagtskema med faste vagter og mini-teams til at skabe støtte og gode rammer for en god balance mellem arbejde og privat liv for at reducere burn-out • Gennemsnit 12 - 14 tilkaldevagter per jordemoder per skema med to jordemødre på kald hver nat