Challenges to the improvement of obstetric care in maternity hospitals of a large Brazilian city: an exploratory qualitative approach on contextual issues

Abstract Background Maternal morbidity and mortality are still serious public health concerns in Brazil, and access to quality obstetric care is one critical point of this problem. Despite efforts, obstetric care quality problems and sub-optimal/poor outcomes persist. The study aimed to identify con...

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Main Authors: Margareth Crisóstomo Portela, Sheyla Maria Lemos Lima, Lenice Gnocchi da Costa Reis, Mônica Martins, Emma-Louise Aveling
Format: Article
Language:English
Published: BMC 2018-11-01
Series:BMC Pregnancy and Childbirth
Subjects:
Online Access:http://link.springer.com/article/10.1186/s12884-018-2088-3
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author Margareth Crisóstomo Portela
Sheyla Maria Lemos Lima
Lenice Gnocchi da Costa Reis
Mônica Martins
Emma-Louise Aveling
author_facet Margareth Crisóstomo Portela
Sheyla Maria Lemos Lima
Lenice Gnocchi da Costa Reis
Mônica Martins
Emma-Louise Aveling
author_sort Margareth Crisóstomo Portela
collection DOAJ
description Abstract Background Maternal morbidity and mortality are still serious public health concerns in Brazil, and access to quality obstetric care is one critical point of this problem. Despite efforts, obstetric care quality problems and sub-optimal/poor outcomes persist. The study aimed to identify contextual elements that would potentially affect the implementation of an obstetric care quality improvement intervention. Methods A qualitative study was conducted in three public maternity hospitals of a large Brazilian city, with high annual volume of births and buy-in from high-level managers. Individual interviews with doctors and nurses were conducted from July to October 2015. Semi-structured interviews sought to explore teamwork, coordination and communication, and leadership, being open to capture other contextual elements that could emerge. Interviews were recorded and transcribed, and the categories of analysis were identified and updated based on the constant comparative method. Results Twenty-seven interviews were carried out. Extra-organizational context concerning the dependence of the maternity hospitals on primary care units, responsible for antenatal care, and on other healthcare organizations’ services emerged from interviews, but the main findings of the study centered on intra-organizational context with potential to affect healthcare quality and actions for its improvement, including material resources, work organization design, teamwork, coordination and communication, professional responsibility vis-à-vis the patient, and leadership. A major issue was the divergence of physicians' and nurses' perspectives on care quality, which in turn negatively affected their capacity to work together. Conclusion Overall, the findings suggest that care on the maternity hospitals was fragmented and lacked continuity, putting at risk the quality. Redesigning work organization, promoting conditions for multi-professional teamwork, better communication and coordination, improving more systemic accountability/lines of authority, and investing in team members’ technical competence, and fitness of organizational structures and processes are all imbricated actions that may contribute to obstetric care quality improvement.
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spelling doaj.art-27f89b74272a441993b45fbf7f86c2be2022-12-22T02:42:42ZengBMCBMC Pregnancy and Childbirth1471-23932018-11-011811910.1186/s12884-018-2088-3Challenges to the improvement of obstetric care in maternity hospitals of a large Brazilian city: an exploratory qualitative approach on contextual issuesMargareth Crisóstomo Portela0Sheyla Maria Lemos Lima1Lenice Gnocchi da Costa Reis2Mônica Martins3Emma-Louise Aveling4Department of Health Administration and Planning, National School of Public Health, Oswaldo Cruz FoundationDepartment of Health Administration and Planning, National School of Public Health, Oswaldo Cruz FoundationDepartment of Health Administration and Planning, National School of Public Health, Oswaldo Cruz FoundationDepartment of Health Administration and Planning, National School of Public Health, Oswaldo Cruz FoundationDepartment of Health Policy and Management, Harvard T.H. Chan School of Public HealthAbstract Background Maternal morbidity and mortality are still serious public health concerns in Brazil, and access to quality obstetric care is one critical point of this problem. Despite efforts, obstetric care quality problems and sub-optimal/poor outcomes persist. The study aimed to identify contextual elements that would potentially affect the implementation of an obstetric care quality improvement intervention. Methods A qualitative study was conducted in three public maternity hospitals of a large Brazilian city, with high annual volume of births and buy-in from high-level managers. Individual interviews with doctors and nurses were conducted from July to October 2015. Semi-structured interviews sought to explore teamwork, coordination and communication, and leadership, being open to capture other contextual elements that could emerge. Interviews were recorded and transcribed, and the categories of analysis were identified and updated based on the constant comparative method. Results Twenty-seven interviews were carried out. Extra-organizational context concerning the dependence of the maternity hospitals on primary care units, responsible for antenatal care, and on other healthcare organizations’ services emerged from interviews, but the main findings of the study centered on intra-organizational context with potential to affect healthcare quality and actions for its improvement, including material resources, work organization design, teamwork, coordination and communication, professional responsibility vis-à-vis the patient, and leadership. A major issue was the divergence of physicians' and nurses' perspectives on care quality, which in turn negatively affected their capacity to work together. Conclusion Overall, the findings suggest that care on the maternity hospitals was fragmented and lacked continuity, putting at risk the quality. Redesigning work organization, promoting conditions for multi-professional teamwork, better communication and coordination, improving more systemic accountability/lines of authority, and investing in team members’ technical competence, and fitness of organizational structures and processes are all imbricated actions that may contribute to obstetric care quality improvement.http://link.springer.com/article/10.1186/s12884-018-2088-3Quality improvementObstetric careOrganizational contextImprovement scienceQualitative approach
spellingShingle Margareth Crisóstomo Portela
Sheyla Maria Lemos Lima
Lenice Gnocchi da Costa Reis
Mônica Martins
Emma-Louise Aveling
Challenges to the improvement of obstetric care in maternity hospitals of a large Brazilian city: an exploratory qualitative approach on contextual issues
BMC Pregnancy and Childbirth
Quality improvement
Obstetric care
Organizational context
Improvement science
Qualitative approach
title Challenges to the improvement of obstetric care in maternity hospitals of a large Brazilian city: an exploratory qualitative approach on contextual issues
title_full Challenges to the improvement of obstetric care in maternity hospitals of a large Brazilian city: an exploratory qualitative approach on contextual issues
title_fullStr Challenges to the improvement of obstetric care in maternity hospitals of a large Brazilian city: an exploratory qualitative approach on contextual issues
title_full_unstemmed Challenges to the improvement of obstetric care in maternity hospitals of a large Brazilian city: an exploratory qualitative approach on contextual issues
title_short Challenges to the improvement of obstetric care in maternity hospitals of a large Brazilian city: an exploratory qualitative approach on contextual issues
title_sort challenges to the improvement of obstetric care in maternity hospitals of a large brazilian city an exploratory qualitative approach on contextual issues
topic Quality improvement
Obstetric care
Organizational context
Improvement science
Qualitative approach
url http://link.springer.com/article/10.1186/s12884-018-2088-3
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