Table 5 Institutionalization and routinization of ML-AC as reported by study participants
From: Sustainability of hospital-based midwife-led antenatal care consultation — a qualitative study
Managers | Midwives | Physicians | |
|---|---|---|---|
Institutionalization (implies the concretization of organizational infrastructure and integration of a change in subsystems [6]) | |||
Staff budget (Unit level) | Hospital A: Overtime, Hospital B: Donations - After about two years increase in number of midwives positions in both hospitals | Separate timetable for midwives offering ML-AC | |
Time slots for ML-AC appointments (Personal level) | - Hospital A: 30 min. Then 45 min, every day - Hospital B: 30 min. Two days/week - Last trimester of pregnancy | - Hospital A: 30 min. Then 45 min, every week day - Hospital B: 30 min. Two days/week - Last trimester of pregnancy | |
Room for consultation (Organizational level) | Difficult to obtain a room, lots of discussions | Hospital A: Room without a window | |
Organizational infrastructure (Organizational level) | - Good collaboration - between midwives and physicians. Consultation with physician on short notice, if needed. - Hospital B: 1/year meeting with physicians, 2–3/year monthly meeting of the midwives | Good collaboration between midwives and physicians. Consultation with physician on short notice, if needed | Good collaboration between midwives and physicians |
Routinization (pertains to cycles of repeated action in practice and organizational routines [6]) | |||
Structural organization (Organizational level) | Appointments by outpatient services Checking appointments Hospital A: Women fill in medical record and birth plan. Midwives add information if necessary Hospital B: Midwives fill in documents together with women during appointment. If necessary, consultation with physicians of outpatient services | If necessary, consultation with physicians of outpatient services. Documentation of consultation in maternal care record. Copy of documents stays in the delivery unit. Content of documents are discussed upon arrival between midwives in the delivery unit and birthing woman | Consultation with physician on short notice, if needed |