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The implementation of the integrated birth care policy in the Netherlands. A process evaluation

Schenau, Judith (2020) The implementation of the integrated birth care policy in the Netherlands. A process evaluation.

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Abstract:Background The Netherlands had one of the highest perinatal mortality rates in Europe in 2004. The figures showed that the perinatal death rate in the Netherlands was above the European average. To address this, the Minister of Health, Welfare and Sport appointed the Steering Committee on Pregnancy and Birth. They created an advice report to optimize birth care, which especially emphasized that more intensive cooperation between all birth care professionals was needed and thus an integrated approach. They also advised that College Perinatale Zorg (CPZ) should be established to create and facilitate the Integrated Birth care Standard (ZIG). The ZIG was established in 2016, the policy that was described was mandatory for all care providers involved in birth care and the implementation had a timeframe of four years. Since the advice of the steering group, the figures of the perinatal death rate have fallen in the Netherlands but have flattened in recent years. This could have something to do with the fact that the integrated birth care policy has not been optimally implemented yet, therefore it was important that this was examined. Objective The primary aim of this study was to gain insight on whether the integrated birth care policy has been implemented as intended and to what extent in the form of a process evaluation of the policy of the ZIG. The focus was on the implementation phase. Method This study focused on the implementation of the integrated birth care policy. First, a content analysis was carried out in which it became clear which activities, objectives and responsible actors were described for the integrated birth care policy. It became clear that two layers of implementers were appointed. The local obstetric partnerships (VSVs) and the National umbrella organisations involved in birth care. These two layers were examined. For the VSVs existing data has been used which were telephone interviews from CPZ and indicator results. Both methods included the performance of certain activities that were to be performed by the VSVs. When an activity occurred in both datasets, the results could be compared in the activity analysis. Next to that an overall analysis, based on the telephone interviews, of the VSVs was performed which presented to what extent all activities have been carried out by all VSVs. In addition, the distribution of the VSVs was examined in the form of a group analysis. They could be divided into a low group, average group, and high group. Semi-structured interviews were held with the National umbrella organisations about their contribution to the implementation of the ZIG. Next to that the factors influencing implementation were discussed. 4 Results The telephone interviews and the indicator set were analysed when it came to the VSVs and it became clear that the activities that were best performed: Working with integral care paths and or protocols, a quality policy, multidisciplinary consultation (MDO) and client experience measurement. Activities that were carried out the least were: Working with an integral dossier, client participation, a coordinating care provider and working with an individual birth care plan. On the latter two the indicator however showed that most VSVs carried out those activities. The VSVs were also divided into three groups when it came to the implementation of the ZIG. 30% of the 57 VSVs were in the high group, 30% of the VSVs in the average group and another 30 % in the low group. The high scoring group of VSVs scored reasonably high on all activities except for working with an integral dossier. The average group was shown that working with integral care paths or and protocols, client experience measurement, MDO and a quality policy were carried out by the majority of this group. The activities that were carried out the least by this group were: Client participation, individual birth care plan and joint website. These scored all below the 50 %. For client participation it is however shown that there is a high level of not discussed as for working with an individual birth care plan. Regarding the low group the level of ‘’Not discussed’’ stood out, since for nearly every activity this was above 60%. The activity that was carried out the most by this group was: Integral care paths or and protocols. It also became apparent that the level of ‘’In development’’ was low for all activities. Interviews were conducted with Bo geboortezorg, Koninklijke Nederlandse Organisatie van Verloskundigen (KNOV), Nederlandse Vereniging voor Obstetrie en Gynaecologie (NVOG), Federatie van VSV’s, Patiëntenfederatie Nederland, CPZ, ZonMw and Perined. It became clear that activities that had to do with an association other than their own, were carried out the least by Bo geboortezorg, KNOV, NVOG and the Federatie van VSVs. Next to that the activity regarding risk assessment was carried out the least. An activity concerning the development of monodisciplinary guidelines into multidisciplinary guidelines was also carried out the least. For Patiëntenfederatie Nederland it became apparent that they were engaged in most activities that were described for them. The activities that were not carried were: Carry out own activities that promote the application of integrated birth care in accordance with the Integrated Birth care Standard, looking for cooperation and synergy between own activities and the activities of healthcare professionals and professional associations and communication about relevant aspects of the Integrated Birth care Standard, including trying to get pregnant women / parents involved in participation in advisory boards of VSVs. CPZ carried out nearly every activity. The only activity that was not carried out was: Supports the VSVs in their choices when working together in a shared electronic file. For Perined and ZonMw it became apparent that they both fulfil a role when it comes to integrated birth care, although no activities were described for them in the implementation plan. When it comes to the factors of influence the policy and policy theory, the implementing organisation, the implementers, and the characteristics of the environment played an important role. When it comes to the policy and policy theory factors that were of influence are: inaccuracies in the implementation plan, time pressure in the development of the implementation plan, overambitious objectives, the 5 necessary resources were not in order when it comes to capacity and finance, incorrect assumptions about the degree of organization within a VSV and the digital data exchange. Regarding the implementing organisation factors that were of influence were: The existence of CPZ, Confusion about the role of CPZ, The image of CPZ, first communication outing to the field. When it comes to implementers several factors played a role such as: the differences between professionals, lack of trust between professionals, disagreements about some objectives. Concerning the environment factors that were of influence were: The implementation of the integrated birth care policy and integrated funding intertwined, distracting riot around a client experience measurement and the practical help consortia offered VSVs. Conclusion The conclusion of this study is that the implementation of integrated birth care is on the right track. However, the integrated birth care policy is not totally implemented as intended. There is variation between VSVs as between the different National umbrella organizations. The VSVs carried out the minority of activities. The activities that were carried out by the majority of the VSVs were: working with integral care paths or protocols, client experience measurements, MDO and a quality policy. The indicator set showed that working with an individual birth care plan and a coordinating care provider were carried out by the majority. It can therefore not be said with certainty that the VSVs carried out the minority of the activities. Furthermore, were most activities carried out in different ways. The activities that have not been performed as intended based on the overall analysis were: Working with multidisciplinary training, joint website, client participation and integral dossier, individual birth care plan and coordinating care provider. Whether the policy was carried out as intended differed per National umbrella organization. CPZ, the KNOV and Bo geboortezorg carried out most of the activities that were described for them. For CPZ it became clear that the ‘’who’’ changed hey however did carry out the ‘’what’’. The organizations that carried out the minority of the activities they were supposed to, were the NVOG and Patiëntenfederatie Nederland. This also applies to the federatie van VSVs, but at the time when the implementation plan was drawn up, they did not yet exist, so they were not mentioned as a national umbrella organization in the implementation plan. If the policy had been implemented as intended all activities were carried out by the organizations that had to do so, this is however often not the case as for this policy.
Item Type:Essay (Master)
Faculty:TNW: Science and Technology
Subject:85 business administration, organizational science
Programme:Health Sciences MSc (66851)
Link to this item:https://purl.utwente.nl/essays/85408
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