Dear Rachel
I suspect your experience is a reflection of the personalities and their
power structure rather than adverse events analysis
I only have a midwifery based experience of adverse events analysis and I
felt it was an intersting structure which gave form and direction and which
I feel we used
as it was intended to address what can be done better to lessen the risk of
a recurrence.
Nothing is perfect when people are involved this is another way of looking
at a situation which can as you have experienced can be abused!!
Denise Hynd
"Let us support one another, not just in philosophy but in action, for the
sake of freedom for all women to choose exactly how and by whom, if by
anyone, our bodies will be handled."
- Linda Hes
----- Original Message -----
From: "wump fish" <[EMAIL PROTECTED]>
To: <[email protected]>
Sent: Sunday, October 30, 2005 11:45 AM
Subject: RE: [ozmidwifery] risk management
I just think that the there are a number of problems generated by applying
the current risk management strategies in health care to midwifery care.
The strategies centred around adverse events analysis claim to be focussed
on systems and not individuals. However, this is often not how they are
perceived by those involved in the events. In the UK we had 'risk
management meetings' every morning to discuss the events in the last
24hrs. Everyone was invited, but of course most midwives were busy caring
for women and couldn't get to them. Instead management and the drs sat
around and used the notes to discuss care (no names but everyone knew who
was involved), the risk of litigation and improvements etc. This was very
intimidating for the midwives and was referred to as 'the lynch mob' or
the 'witch hunt'.
These meetings often totally missed the point because they were focussed
on what the participants thought was important - not the women. For
example, one of the women I cared for postnatally had had an emergency
c-section for fetal distress. The baby ended up with a cut on his face and
the meeting discussed the cut. The mother did not give a stuff about the
cut on her baby's face, but I spent many hours at her house due to the
psychological effects of her experience during an unneccesary fetal blood
sampling (flash backs, nightmares, anxiety attacks etc). They would
analyse and discuss a poor forceps birth and how to improve the
technique - but would not discuss and analyse how this OP baby could have
been encouraged to rotate during labour so that the forceps did not need
to be used in the first place. I became quite famous at these meeting for
my opinionated and arsey contributions - it was almost fun throwing
spanners (and research) in the works.
Re-focusing risk managment onto optimal outcomes rather than adverse
outcomes my be more appropriate and lead to improvements in women's birth
experiences. There is a good chapter in Normal Childbirth: evidence and
debate (ed Soo Downe) about risk, safety etc. If our aim was to improve
outcomes - ie. women's satisfaction with their birth experiences,
increasing the normal birth rate etc, we may find the system starts to
change in our favour. Looking at why things go well rather than why they
go wrong. Education could focus on facilitating physiological birth and
improving the birth experience and very importantly - information giving.
Obviously midwives still need education in dealing with emergencies, but
preventing emergencies should be given equal weighting.
Ok, end of my opinionated and arsey contribution ; )
Rachel
From: "Mary Murphy" <[EMAIL PROTECTED]>
Reply-To: [email protected]
To: <[email protected]>
Subject: RE: [ozmidwifery] The Advertiser today...
Date: Sun, 30 Oct 2005 10:26:53 +0800
Rachel, working in homebirths makes me very interested in risk management
and education. I would appreciate "hearing" what you have to say, so rave
on. Mary M
There is kudo is being competent in
the management of abnormal and emergencies. Unfortunately, there is not
the
same emphasis placed on the skills involved in facilitating physiological
birth and preventing those emergencies from occuring in the first place.
Risk management strategies are also back-to-front and result concentrate
on
the symptoms ignoring the cause. Anyhow... I could rant on forever about
risk management and education. So I will shut up for now.
Rachel x
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