Diversity in the Scope and Practice of Hospital-Based Midwives in the Netherlands

Prevention, Population and Disease management (PrePoD

Resample-smoothing of Voronoi intensity estimators

Voronoi estimators are non-parametric and adaptive estimators of the intensity of a point process. The intensity estimate at a given location is equal to the reciprocal of the size of the Voronoi/Dirichlet cell containing that location. Their major drawback is that they tend to paradoxically under-smooth the data in regions where the point density of the observed point pattern is high, and over-smooth where the point density is low. To remedy this behaviour, we propose to apply an additional smoothing operation to the Voronoi estimator, based on resampling the point pattern by independent random thinning. Through a simulation study we show that our resample-smoothing technique improves the estimation substantially. In addition, we study statistical properties such as unbiasedness and variance, and propose a rule-of-thumb and a data-driven cross-validation approach to choose the amount of smoothing to apply. Finally we apply our proposed intensity estimation scheme to two datasets: locations of pine saplings (planar point pattern) and motor vehicle traffic accidents (linear network point pattern)

How good is collaboration between maternity service providers in the Netherlands?

Doug Cronie,1,2 Marlies Rijnders,3 Suze Jans,3,4 Corine J Verhoeven,5,6 Raymond de Vries7–9 1Department of Midwifery, OLVG (West) Hospital, Amsterdam, The Netherlands; 2Department of Midwifery Science, Faculty of Public Health and Primary Care, University of Maastricht, Maastricht, The Netherlands; 3Department of Child Health, TNO, Leiden, The Netherlands; 4Editorial Department, Dutch Journal for Midwives (KNOV), Utrecht, The Netherlands; 5Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands; 6Department of Obstetrics and Gynecology, Maxima Medical Centre, Veldhoven, The Netherlands; 7Faculty of Midwifery Education & Studies, Zuyd University, Maastricht, The Netherlands; 8CAPHRI, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; 9Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI, USA Aims: To examine the experiences of inter-professional collaboration of maternity service providers in the Netherlands and to identify potential enhancing and inhibiting factors for inter-professional collaboration within maternity care in the Netherlands. Background: Good collaboration between health care professionals is a key element of safe, effective care, but creating a collaborative culture can be challenging. Good collaboration requires, among other things, negotiating different professional orientations and the organizational constraints of hierarchies and scheduling. Good collaboration is especially important in maternity care. In the Netherlands, suboptimal collaboration has been cited as a significant factor in maternal deaths and in adverse incidents occurring in hospitals during evenings, nights, and weekends. In spite of its importance for effective maternity care, little is known about the nature and quality of collaboration between maternity care professionals. In order to fill this gap, we examined the inter-professional collaboration within multi-disciplinary teams (MDTs) providing maternity services in the Netherlands. Methods: Online survey of MDTs (consisting of hospital and PCMs, doctors, and carers) involved in the provision of maternity services in the Netherlands. We used a validated measure of collaboration (the Leiden Quality of Work Questionnaire) to analyze the attitudes of those involved in the provision of maternity services about multi-disciplinary collaboration in their work. We used descriptive and inferential statistics to assess differences between the groups. Results: 40% of all respondents were not satisfied with collaboration within their MDT. Overall, mean collaboration scores (MCS) were low. We found significant differences in MCS between professional groups. Midwives – community and hospital based – were pessimistic about collaboration in future models of maternity care. Discussion: In the Netherlands, collaboration in maternity care is less than optimal. Poor collaboration is associated with negative consequences for patient safety and quality of care. Strategies to address suboptimal collaboration exist; however, no one-size-fits-all approach is identified in the literature. Conclusion: Suboptimal collaboration exists within the midwifery model of care in the Netherlands and the relationship between care providers is under pressure. This could affect patient safety and quality of care, according to the literature. Précis: This paper presents an in-depth examination of the nature of, and attitudes about, collaboration between members of the MDT involved in the provision of maternity services in the Netherlands. Keywords: interprofessional communication, communication, multi-disciplinary team, interprofessional teamwork, interprofessional collaboration survey, questionnaire hospital midwife, primary care midwife, midwifery, carer, doctor, nurse, maternity care assistant, integrated-car

(Un)warranted variation in local hospital protocols for neonatal referral to the pediatrician: An explorative study in the Netherlands

Background Studies indicate unwarranted variation in a wide range of neonatal care practices, contributing to preventable morbidity and mortality. Unwarranted variation is the result of complex interactions and multiple determinants. One of the determinants contributing to unwarranted variation in care may be variation in local hospital protocols. The purpose of this study was to examine variation in the content of obstetric and neonatal protocols for six common indications for neonatal referral to the pediatrician: large for gestational age/macrosomia, small for gestational age/fetal growth restriction, meconium-stained amniotic fluid, vacuum extraction, forceps extraction, and cesarean birth. Methods We conducted a nationwide cross-sectional study examining protocols for neonatal referral to the pediatrician in the obstetric and neonatal departments of all Dutch hospitals. Variation in protocols was analyzed between regions, between neonatal and obstetrics departments located in the same hospital, and within neonatal and obstetrics departments. Results There was considerable variation in protocols between regions, between neonatal and obstetrics departments, and within neonatal and obstetrics departments. The results of this study showed considerable variation in recommendations for type of referral, admission, screening/diagnostic tests, treatment, and discharge. Furthermore, results generally showed lower referral thresholds in neonatal departments compared with obstetric departments, and higher referral thresholds in the eastern region of the Netherlands. We also found variation in local hospital protocols, which could not be explained by population characteristics but which may be explained by varying recommendations in existing national and international guidelines and/or lack of adherence to these guidelines. Conclusions To reduce unwarranted variation in local protocols, evidence-based, multidisciplinary guidelines should be developed in the Netherlands. Further research addressing knowledge gaps is needed to inform these guidelines. Attention should be paid to the implementation of evidence, and only where evidence is lacking or inconclusive should agreements be based on multidisciplinary consensus. Where protocols deviate from evidence-based guidelines because of specific local circumstances, clearer, more transparent justifications should be made. Uniformity in guidance will offer clear standards for care evaluation and provide opportunities to reduce inappropriate care

Experienced job autonomy among maternity care professionals in The Netherlands.

Objective: High levels of experienced job autonomy are found to be beneficial for healthcare professionals and for the relationship with their patients. The aim of this study was to assess how maternity care professionals in the Netherlands perceive their job autonomy in the Dutch maternity care system and whether they expect a new system of integrated maternity care to affect their experienced job autonomy. Design: A cross-sectional survey. The Leiden Quality of Work Life Questionnaire was used to assess experienced job autonomy among maternity care professionals. Setting: Data were collected in the Netherlands in 2015. Participants: 799 professionals participated of whom 362 were primary care midwives, 240 obstetricians, 93 clinical midwives and 104 obstetric nurses. Findings: The mean score for experienced job autonomy was highest for primary care midwives, followed by obstetricians, clinical midwives and obstetric nurses. Primary care midwives scored highest in expecting to lose their job autonomy in an integrated care system. Key conclusions: There are significant differences in experienced job autonomy between maternity care professionals. Implications for practice: When changing the maternity care system it will be a challenge to maintain a high level of experienced job autonomy for professionals. A decrease in job autonomy could lead to a reduction in job related wellbeing and in satisfaction with care among pregnant women