200 Chapter 7 reliability of the data analysis was enhanced by discussing the analysis process between all authors. CLOSING REMARKS This dissertation shows that task shifting aCTG for specific indications from OLC to MLC is an example of value-based maternity care; it adds value as the continuity of care improved for most women who had an MLC-aCTG without compromising the quality of care, and women who had an aCTG in midwife-led care were highly satisfied with this care. On the other hand, it reduces the health care reimbursement. However, new developments come with challenges, and successful implementation of task-shifting is not self-evident. A quote from Machiavelli applies perfectly to this change in the care pathway; ‘The initiative to introduce change is the most difficult challenge, the most dangerous implementation, and the most uncertain outcome.’ Healthcare professionals in the CTG pilot dared to take the initiative to introduce a change in maternity care and showed that with trust and good collaboration with each other, their organizations, and client representatives, a successful healthcare improvement could be initiated. It is time to put aside all prejudices, prioritize the pregnant woman, and work together in training and research. There is a diverse group of healthcare professionals available, both inside and outside the hospital, with varying backgrounds, ideas, and qualities. Ideally, the way care is organized should stimulate every healthcare professional to work to the best of their ability. Care should be organized around the patient’s journey during the pregnancy and maternity period. Professionals must dare to learn from each other and involve the pregnant woman herself in improving care outcomes. This will create an inspiring and motivating learning environment that benefits the pregnant woman and her family in particular, as well as the professionals themselves. By coming together, a movement can be initiated nationally and internationally to create a maternity care system that facilitates healthcare professionals in their pursuit of the best possible quality per euro spent on healthcare: care driven by value.
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