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

Abstract

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.

Publication DOI: https://doi.org/10.1136/bmjopen-2021-059428
Divisions: College of Business and Social Sciences > School of Social Sciences & Humanities
College of Business and Social Sciences > School of Social Sciences & Humanities > Sociology and Policy
College of Business and Social Sciences > School of Social Sciences & Humanities > Centre for Health and Society
Additional Information: © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
Uncontrolled Keywords: Female,Gestational Age,Humans,Infant,Infant, Newborn,Infant, Premature, Diseases,Intensive Care Units, Neonatal,Mothers,Pregnancy,Qualitative Research
Publication ISSN: 2044-6055
Last Modified: 10 Apr 2024 07:22
Date Deposited: 01 Jul 2022 11:02
Full Text Link:
Related URLs: https://bmjopen ... /6/e059428.info (Publisher URL)
http://www.scop ... tnerID=8YFLogxK (Scopus URL)
PURE Output Type: Article
Published Date: 2022-06-27
Accepted Date: 2022-05-13
Submitted Date: 2021-11-20
Authors: Cupit, Caroline
Paton, Alexis (ORCID Profile 0000-0003-4310-6983)
Boyle, Elaine
Pillay, Thillagavathie
Armstrong, Natalie
Banda, Victor L
Bountziouka, Vasiliki
Dawson, Kelvin
Draper, Elizabeth S
T Ismail, Abdul Qader
Manktelow, Bradley
Modi, Neena
Rivero-Arias, Oliver
Seaton, Sarah E
Yang, Miaoqing
, For the OPTI-PREM Study Team

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