158 Chapter 6 If community midwives do not have adequate provisions to relieve them of personal obligations to be free to respond to need when arises, then they may choose not to engage with MLCC. If midwifery practices struggle to cover all shifts and clinics due to a shortage of midwives, then they will see few opportunities to implement (elements of) MLCC. If community midwives decrease their caseload in order to provide MLCC, then more community midwives are needed to be able to provide care for the same number of women. If the number of referrals to secondary care decrease due to MLCC in primary care, then hospitals lose financial income and may not be able to keep providing care in the long term. If there is a capacity problem in secondary care, then care providers will be motivated to explore opportunities to collaborate with community midwives, and create possibilities for them to provide MLCC. Organisational aspects If organisational aspects hinder implementation of MLCC, then the motivation of maternity care providers to implement MLCC is decreased. If policy rules and regulations do not fit the implementation of MLCC, then organisations do not have the resources to actually make (elements of) MLCC a reality. If there is a lack of shared understanding between maternity care professionals and directors about each other’s needs in the different ways of working, then they will not consider ways to implement MLCC. If midwives do not trust the organisation to manage the implementation of MLCC properly or have had previous poor experience of change management within the organisation, then they will not engage with the changes required, because they are frightened of the impact on them personally and professionally. If implementation of MLCC comes with uncertainties or consequences for those directly involved, then the motivation for the implementation of MLCC will be reduced. If maternity care providers within an organisation are unable to, do not want to, or are afraid of change, then they will overtly or covertly undermine efforts to make MLCC happen. If there is a motivated, visible, understanding and approachable leader during implementation of MLCC, then there is more trust regarding implementation and all phases of implementation are well completed on all levels of an organisation. If professional and organisational interests of stakeholders do not match with the objectives of MLCC, then it is not possible to reach an agreement, and therefore no (elements of) MLCC will be implemented. If there is a hierarchical structure within an organisation, then it is not possible to reach an equal value agreement, because interdependencies and different power relations are present.
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