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. 2023 May 20;23(1):368.
doi: 10.1186/s12884-023-05641-2.

Reflective, pragmatic, and reactive decision-making by maternity service providers during the SARS-CoV-2 pandemic health system shock: a qualitative, grounded theory analysis

Sergio A Silverio  1 , Kaat De Backer  2 , Jeremy M Brown  3 , Abigail Easter  2 , Nina Khazaezadeh  4 , Daghni Rajasingam  5 , Jane Sandall #  2 , Laura A Magee #  6
Affiliations

Reflective, pragmatic, and reactive decision-making by maternity service providers during the SARS-CoV-2 pandemic health system shock: a qualitative, grounded theory analysis

Sergio A Silverio et al. BMC Pregnancy Childbirth. .

Abstract

Background: Pregnant and postpartum women were identified as having particular vulnerability to severe symptomatology of SARS-CoV-2 infection, so maternity services significantly reconfigured their care provision. We examined the experiences and perceptions of maternity care staff who provided care during the pandemic in South London, United Kingdom - a region of high ethnic diversity with varied levels of social complexity.

Methods: We conducted a qualitative interview study, as part of a service evaluation between August and November 2020, using in-depth, semi-structured interviews with a range of staff (N = 29) working in maternity services. Data were analysed using Grounded Theory analysis appropriate to cross-disciplinary health research.

Analysis & findings: Maternity healthcare professionals provided their views, experiences, and perceptions of delivering care during the pandemic. Analysis rendered three emergent themes regarding decision-making during reconfigured maternity service provision, organised into pathways: 1) 'Reflective decision-making'; 2) 'Pragmatic decision-making'; and 3) 'Reactive decision-making'. Whilst pragmatic decision-making was found to disrupt care, reactive-decision-making was perceived to devalue the care offered and provided. Alternatively, reflective decision-making, despite the difficult working conditions of the pandemic, was seen to benefit services, with regards to care of high-quality, sustainability of staff, and innovation within the service.

Conclusions: Decision-making within maternity care was found to take three forms - where at best changes to services could be innovative, at worst they could cause devaluation in care being delivered, and more often than not, these changes were disruptive. With regard to positive changes, healthcare providers identified staff empowerment, flexible working patterns (both for themselves and collectively as teams), personalised care delivery, and change-making in general, as key areas to capitalise on current and ongoing innovations borne out of the pandemic. Key learnings included a focus on care-related, meaningful listening and engagement of staff at all levels, in order to drive forward high-quality care and avoid care disruption and devaluation.

Keywords: COVID-19; Decision-making; Health system shock; Healthcare professionals; Maternity care; SARS-CoV-2 pandemic; Service reconfiguration.

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Conflict of interest statement

Kaat De Backer, Abigail Easter, & Jane Sandall (King’s College London) are currently supported by the National Institute for Health and Care Research Applied Research Collaboration South London [NIHR ARC South London] at King’s College Hospital NHS Foundation Trust. Sergio A. Silverio is in receipt of a Personal Doctoral Fellowship from the NIHR ARC South London Capacity Building Theme [ref:- NIHR-INF-2170] and Jane Sandall is an NIHR Senior Investigator Emerita [ref:- NIHR200306]. Kaat De Backer was previously supported by the National Institute for Health and Care Research Applied Research Collaboration East of England [NIHR ARC East of England] at Cambridgeshire and Peterborough NHS Foundation Trust and is now funded by an NIHR Doctoral Fellowship. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. All other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Final theory
See this image and copyright information in PMC

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