The process of implementation of OMGP: staff experiences of service change

Abstract

Background

In 2023 our service introduced “OMGP”, the obstetric-medicine midwifery group practice model of care for women with complex medical care needs. OMGP is a collaborative, woman-centred model incorporating obstetrics, obstetric medicine, credentialled diabetes educators, and midwifery group practice.

Aim

To qualitatively explore knowledge and expectation of staff prior to its adoption and at a year post-implementation.

Methods

This study utilised profession-specific focus groups with OMGP staff (obstetricians, obstetric medicine physicians, credentialled diabetes educators, and midwifery group practice midwives) at baseline and 12 months post-implementation. Questions focused on understanding of and thoughts about the OMGP model of care, as well as important considerations for managing diabetes in pregnancy.

Findings

At baseline, the main theme relating to OMGP related to continuity of care. The main theme relating to how OMGP differs from usual models focused on enhanced benefits from interprofessional collaboration. Three themes existed around diabetes in pregnancy, including clinical knowledge, procedural concerns and professional boundaries. Initial expectations were broadly positive, acknowledging potential for scalability, but with caution regarding role clarity and adaption to change. A year following the model’s implementation, three themes were identified. These were: the benefits of a coordinated care delivery model, reflections and realisations, and embedding and strengthening, focusing on administrative/ procedural and systemic aspects of care delivery, highlighting areas for improvement and monitoring.

Conclusion

The insights of each professional group informed preparation for the launch of the model of care. Over time the model was successfully embedded, enhancing care coordination and delivery.

Statement of significance

Issue: Women with complex medical needs during pregnancy often experience fragmented and medicalised care, potentially leading to worse outcomes and less satisfaction with care.

What is already known: Continuity of midwifery care has been shown to improve birth outcomes and satisfaction with care for women. However, most evidence of the benefits of continuity of care exists for low to medium-risk cohorts, presenting a barrier to implementation of this model of care for higher medical risk women.

What this paper adds: This qualitative exploration of staff’s expectations and experience prior to and following the introduction of a collaborative, women focussed model of care for women at high medical risk. It revealed how, despite concerns regarding roles, processes, and clinical considerations, a shared goal of continuity of care and respect for interprofessional collaboration, strengthened relationships, interactions and care delivery can be achieved.