140 Chapter 6 Table 2: CMOCs underpinning the two themes Macro-level challenges and Leadership. Macro-level challenges CMO 1 Macro-level challenges Healthcare systems are characterised by complex financial, legal, and regulatory structures. (C) The implementation of MLCC faces systemic constraints, such as financial resources, restrictive legal frameworks governing scope of practice, and regulatory policies that prioritise standard care. (MRc) Government policies, guidelines, and reports that endorse the potential benefits of MLCC, can help to enable the necessary systemic changes and can be seen as inspirational. On the other hand, limited financial resources may result in budget constraints that restrict investments in training and support for interprofessional teams. Restrictive legal frameworks can limit midwives’ autonomy and scope of practice, thus hindering their ability to fully engage in MLCC. Regulatory policies that prioritise standard models of care may create disincentives for healthcare organisations to adopt innovative approaches, such as MLCC. (MRp) Government support and incentives that prioritise MLCC, may lead to maternity care networks embracing MLCC as the preferred model of care. However, macrolevel barriers can lead to micro-level interpersonal conflicts between healthcare providers over roles, responsibilities, and decision-making authority within interprofessional teams. These interpersonal conflicts can undermine trust, communication, and teamwork. As a consequence, healthcare providers may experience tensions, misunderstandings, and power struggles as they navigate competing priorities, perspectives, and expectations within the restrictive maternity care system. (O) 35 37 39-41 43 45 46 54 55 58 60-64 CMO 2 Increasing pressure on healthcare systems Healthcare systems are under increasing pressure to optimise resource allocation and reduce healthcare expenditures while maintaining or improving the quality of services. Maternity care organisations face challenges in recruiting and retaining sufficient numbers of professionals. (C) MLCC emphasises personalised, relational continuity over standardisation, centralisation and efficiency. (MRc) Stakeholders supporting centralisation, may view centralised models as the best way to address staff shortages, ensure access to specialised care, and manage high-risk pregnancies. However, stakeholders supporting MLCC, may view relational continuity as the best way to reduce healthcare expenditure and retain maternity staff, by reducing unnecessary interventions, increasing job satisfaction, and promoting a positive experience for women. (MRp) Competing priorities can lead to polarisation between stakeholders, hindering collaboration. Both groups may act on the belief that they want to provide the best possible care, but may have different beliefs and perspectives on what constitutes the best care. (O) 35 38 43 45 46 49 52 55 57 58 60 61 65 Leadership CMO 3 Support from leaders Leaders within healthcare organisations, such as hospital executives, heads of departments, or clinical directors, have the authority to allocate resources, make policy decisions, and set organisational priorities that determine the models of care provided, including shaping the implementation and integration of new models of care. (C) The transition from standard care to MLCC requires a different allocation of resources, training, and policy changes. Other stakeholders, such as midwives and obstetricians, depend on the decisions and support of leaders to make the transition. (MRc) Leaders who are supportive and active in promoting MLCC can create an enabling environment for MLCC. However, leaders who are hesitant or opposed to MLCC, may be reluctant to allocate resources, invest in training and support, or advocate for policy change. (MRp) The enabling environment created by supportive leaders, can lead to increased buy-in and commitment from other stakeholders. Maternity care networks with leaders who are resistant to MLCC may experience delays, conflicts, or inequities in the provision of MLCC. (O) 16 32 34 35 38 39 42-48 50 52-54 56 66-69
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