Midwifery (1989)5, I72-181

© Longman Group UK Ltd I989

Midwifery 0266 6138/89/0005 172/$10.00

Developing a m i d w i f e r y workload
management system: a preliminary report

Gaynor D Maclean and Hazel I Bowden

Individualised care, quality assurance and resource m a n a g e m e n t are words f r e q u e n t l y

on the lips o f midwives today. This p a p e r describes a project c u r r e n t l y being
u n d e r t a k e n in West G l a m o r g a n H e a l t h A u t h o r i t y w h e r e these criteria each form an
i m p o r t a n t p a r t o f the study. It is in considering these v a r y i n g aspects c o n c u r r e n t l y t h a t
the authors claim a u n i q u e a p p r o a c h . Resources are only considered to be m a n a g e d
a p p r o p r i a t e l y w h e n client centred quality care is provided. As an additional benefit,
the review o f policy and practice and a n e v a l u a t i o n o f the i m p l e m e n t a t i o n o f the
'midwifery process' form an integral p a r t o f the study

midwife or nurse supply. Reid and Melaugh

INTRODUCTION
The potential and incentive for making the best
use of resources has recently received further
impetus in the U K with the Health Service pub-
lication entitled 'Working for Patients' (DOH,
1989).
Midwives are more concerned than ever to
provide an excellent standard of midwifery care
within the given resources. The emphasis in this
project has been to ensure provision of the right
care by the right person at the right time in the
right way. Millar (1989) states that resource
management aims to ensure that patient care will
be managed using facts and figures and not 'gut
feelings' and intuition.
The age of technology has greatly assisted pro-
gress in calculation of client needs matched by
Gaynor D. MacLean, BA, MTD, RGN, RM, Midwifery
Tutor, School of Midwifery, Morriston Hospital,
Cwmrhydyceirw, Swansea SA6 6NL.
Hazel I. Bowden, BSc, PGCE, RM, MBPS, District
Project Nurse (Resource Management), West Glamorgan
Health Authority.
(Requests for offprints to GDM)
Manuscript accepted 24 July 1989
(1988) in a comprehensive study in Northern Ire-
land devised indices to examine the distribution
of midwifery staff in relation to occupied beds in
maternity units. They allowed for the special
factors relevant to midwifery care needs, such as
the presence of 'pairs of patients', i.e. mothers
and babies in postnatal wards, and the particular
needs of labour wards.
Barr (1983; 1984) described a simple tech-
nique of calculating Nursing Hours per Patient
(NHPP) as a ratio,
NHPP = Nursing hours
Number of patients.
Reid and Melaugh (1988) adapted this formula
to reflect the total numbers cared for in postnatal
wards, since, when the ratio of mothers to babies
differed to some extent, the results would be
biased by the choice of the denominator.
Robinson (1980) related the shortage of mid-
wives to the concern of midwives in providing
quality care, given the impetus of the concern
generated by the report of the Select Committee
on Perinatal and Neonatal Mortality (Social

179

/-,00 -I
/ v
,, / \
T\xZ\ xZ
t
150 I I I I I I
Jan Feb Mar Apt May June
Fig. 1 Total births in one unit in West Glamorgan (1985-1988) showing seasonal
variation
Services Committee, 1980) and the Royal Col-
lege of Midwives evidence to the Comparability
Commission (1979). These issues are still very
pertinent and currently relevant in view of the
Wales Perinatal Mortality Initiative (1984-86)
and the recent decisions regarding clinical grad-
ings affecting midwives.
MacFarlane (1978), Cohen (1983) and Reid
and Melaugh (1988) considered variation in
birth patterns. Whilst seasonal variations may re-
flect cultural factors, diurnal and weekly vari-
ations are more likely to be linked with obstetric
practice. Local data (Fig. 1) show seasonal vari-
ations in birth rate which can be used for stra-
tegic planning of establishment levels but will not
significantly aid the matching of client demand
with midwife supply at ward level on a day to
day basis. Planned inductions of labour are
undertaken at a time considered reasonable for
mother, midwife and obstetrician. There are cer-
tain times, e.g. at night and when the labour
ward is very busy, that are almost inevitably con-
sidered unsuitable for induction, though it is
recognised that certain emergency situations
would require prompt intervention, since the
sat~ty and comfort of the woman and her child is
of paramount importance.
Goodbody and Catterall (1984) undertook a
MIDWIFERY 173
--l--- 1985
---[3--
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1986
1987
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July Aug Sep Oct Nov Dec
study into assessing community midwifery staff-
ing requirements, assessing elements of work of
e.g. antenatal assessment, postnatal visits and
travel time, allocating average time required.
From this she derived a simple formula to estim-
ate meaningful funded establishment levels.
An England and Wales Manpower Planning
and Health Visiting Survey (Bowden, 1987) was
carried out to examine the relevance of planning
establishment levels by using existing norms or
ratios. It was found that the relevance of these
criteria do not match client need since this is
purely based on quantitative rather than qualita-
tive data. When Health Authorities set establish-
ment levels against norms, they arrive at a
midwife tianded establishment figure.
J a r m a n (1983) indicated that certain social
variables referred to as 'need indicators' have
been used to calculate scores for specific localities,
which relate to small area statistics census data,
Although he refers to Health Visiting, the same
may be true of Community Midwifery. Bowden
(1987) suggests that 'this approach will enable
efficient deployment of staff through recognised
need in the event of alterations, population
movements, density and structure'.
Rather than relying on norms or ratios, it may
be more appropriate to consider weighting
174 MIDWIFERY

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midwife case loads to take into account social
conditions, linguistic problems, cultural needs
and attitudes, geographical or general practi-
tioner placements. These variables have a time
implication factor which exceeds the otherwise
identified workload.
Ball's (1986) work on midwifery dependency
levels has been incorporated with some of the
principles of J a r m a n (1983) to produce a classifi-
cation system for delivery suites. This is being
tested by Trent Region and Manchester Hos-
pitals. It is said by Ball to be a robust tool.
Background to study
The West Glamorgan Nurse Workload Manage-
ment System (NWMS) has been developed
within the Authority and has resulted in success-
ful implementation of a manual system in 20
wards across the full spectrum of acute general
hospitals. This flexibility allowed the system to be
utilised in the whole of the midwifery division
both in hospital and community.
The present study is believed to be unique in
that as well as taking account of the different
needs of midwifery care in the varying areas in
both hospital and community, the individual
needs of the client are given priority, so that
quality assurance and the assessment of mid-
wifery care plans form an integral part of the
study. It is purported that timing of midwifery
interventions can only be done appropriately
when quality of care is taken into consideration,
as well as assessing hours of effective midwife
supply.
Actual hours of effective midwife supply (S)
are calculated by subtracting 'time out' (TO) for
breaks, meetings, study periods, etc. from duty
hours (dH).
Therefore, it can be stated that:
S = d H -- T O
Client care hours, i.e. D e m a n d (D) are identified
at an agreed standard of care ensuring quality
(oc Q). Thus the following applies:
D o c Q = S.
Systems Griteria
The system has been developed within the cri-
MIDWIFERY 175
teria set by the Welsh Nurse Workload System
(Stephens, 1985). Workload (client demand) is
identified from individual client care plans. This
requires that the system is sensitive to 'workload'
and that this should be undertaken through
measured needs of clients to systematically utilise
manpower resources at an agreed standard of
client care.
Timetable
Preliminary consultations commenced in May
1988 and the project was launched in the mid-
wifery areas in November 1988. The proposed
timetable of the development and implemen-
tation of the M W M S is set out in Table 1. This is
based on a part time research project midwife
and the involvement of the N W M S Team, who
will undertake the planning and co-ordination
and implementation of the study.
A study of labour ward and high dependency
areas will follow that of the antenatal and post-
natal areas, since the former is of considerable
complexity. Through experience in a diversity of
situations found in developing the workload
systems, and from the analysis of the initial data,
it will be possible to work from the less to the
more complex and from the known to the
unknown.
METHODS
The Working Group comprised midwives (clini-
cians, managers and educationalists) who met at
monthly intervals led by the Project Nurse
Team. Group meetings never exceeded 2 hours
because of the degree of technicality and the
necessity of releasing midwives from usual duties.
Most of the detailed writing of standards of care
was undertaken in the midwives' own time.
Meetings were directed at refining and agreeing
standards prior to discussion and final accept-
ance by the Professional Nursing Forum. This
forum comprised Chief Administrative Nursing
OMcer, project nurse, senior clinical/educational
managers, including the Director of Midwifery
Services.
176 MIDWIFERY
Data collection
The method of data collection is based on timings
of interventions agreed by the Working Group.
Local management services practice provided a
percentage allowance for fatigue and con-
tingency (as defined by the International Labour
Office Geneva 1974).
'A small allowance of time which may be in-
eluded in a standard time to meet legitimate
and expected items of work or delays, the pre-
cise measurement of which may be unecono-
mical because of their infrequent or irregular
occurrence'.
To establish total client demand, the following
areas have been identified:
1) Direct Care
2) Indirect Care
3) Shared Administration
D i r e c t c a r e - - T h e Roper et al (1985) Model of
Nursing is used as a basis to identify individual
interventions of client/baby c a r e - - t o include
eating and drinking, eliminating, personal
cleansing and dressing, mobilising. In short, post-
natal care is based on the activities of daily living,
e.g., perineal toilet for mother and bathing for
the baby. Technical interventions were identified
separately, e.g. checking vital signs for mother
and neonatal laboratory screening for baby. The
client/baby care chart (see Fig. 2) is currently
being piloted in a postnatal ward.
Indirect c a r e - - i n c l u d e s the shift/daily total
number of client/baby admissions, discharges,
transfers, paediatrician/obstetrician visits.
Shared a d m i n i s t r a t i o n - - a s a result of gather-
ing information from a ward profile, it was
established that the routine associated with ad-
ministration varied in each ward depending on
the type of care, e.g. antenatal, postnatal. As a
result, a percentage of time is allocated per shift
dependent on who should carry out the duties.
Time is fixed for clerical/domestic and other
appropriate duties, whilst flexible time is based
on the number of clients/babies in the ward.
Ideally domestic duties should be undertaken
by domestic staff but there are situations which,
of necessity, the midwife has to perform, e.g.
within the privacy of the labour room the floor
may need mopping when membranes rupture.
While some duties can thus be shifted from other
staff to the midwife, it is impossible to shift some
workload in the other direction, e.g. midwifery
care planning, handover, teaching and super-
vision of students are unequivocably the task of
the midwife.
A point system was devised for ease of use at
ward level, that is 1 Midwifery Care Point
(MCP) = 6 minutes (see example sheet Fig. 2).
'SNAP' intervention statements (Fig. 3) were
devised to clarify the interpretation of practices
listed in Figure 2.
Actual hours of effective midwife supply were
important to establish. This is carried out with
reference to the criteria set by the Welsh Nurse
Workload M a n a g e m e n t System (Stephens,
1985) and midwifery care hours available
(supply = S) will match client care hours identi-
fied (demand = D) being met at an agreed stand-
ard of care (oc Q), as expressed in the formula
D o c Q = S.
Activity s a m p l i n g
This study has been undertaken in the antenatal
clinic. The aim was to see whether interventions
carried out were at an agreed standard and to
ensure that timings agreed by the working group
were supported. The study also aimed to show
whether the most appropriate person carried out
the work.
Midwives undertook this data collection
under the close supervision of the experienced
project nurse, having been instructed and guided
by management services on the work measure-
ment technique of activity sampling.
In the antenatal clinic, the sampling was
made at 2 minute intervals. One observer mid-
wife was allocated to a maximum of two mid-
wives, working in the clinic. All interventions
were previously coded and midwives were given
an identification letter ('A', 'B', etc.) and clients
were given a number. The observer midwife then
noted the activities of e.g. Midwife 'A' against
specified clients. All interventions identified had
 MIDWIFERY 17 7

Fig. 2 Individual mother/baby care chart--midwifery--postnatal (M = Morning A=Afternoon N = Night)

CLIENT NAME HOSPITAL NO. WARD

Date:
Circle those that apply i

Times M A N M A N M A JN M A N M A N
MOTHER GENERAL CARE
Indep/hyg/diet/bedmade/obs/general postnatal
examination 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
Wash/bath 1 midwife 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
Bath/bed 2 midwife/nurse 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Perineal swabbing 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Toilet/midwife/nurse assist 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Catheterisation 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7
Enema/su ppos/remove catheter 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
BABY GENERAL CARE
Topping/tailing 2 212 I
2 2 2 2 2 2 2 2 2 2 2 2
Nappy/cot change I 1 I I I 1 1 1 I I I I I I I
Bathing (midwife) 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5
Bathing (sup midwife) 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Eye care/ointment/drops/swab 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Examine baby/weigh 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Bottle feeding sup 1/2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Bottle feeding midwife 1/2 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5
Tube feeding 1/2 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
3/4 9 I 9 9 9 9 9 9 9 9 9 9 9 9 9 9
MOTHER AND/OR BABY/OTHER CARE
Breast feeding/assistance 1/2 101010101010101010101010101010
Breast feeding/supervision 1/2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Special vital signs Baby (incl photo therapy) 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
Post operative care Mother 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Oral medication Mother 1 1 1 1 1 1 1 1 1 1 t 1 1 1 1
Oral medication Baby 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
Blood sugar Mother 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
Blood sugar Baby 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
Neonatal/lab screen (PKU) 2 2 2 2 2 2 2
3 2 2 2 2 2 2 2 2
Collect spec urine/faeces/empty urine bag 3 3 3 3 3 3 3 3 3 3 3 3 3 3
Subcut/i.m. injection 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
i.v. injection 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
Comm infusion 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
Discontinue infusion/i.v, insert 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Change i.v. fluid~blood~care 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5
Aseptic dressing/change Redivac 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
Cardiac arrest/other 30 30 30 30 30 30 30 30 301 30 30 30 30 30 30
Assist Dr interventions e.g. VE/any other 5 5 5 5 5 5 5 5 5 5 i
5 5 5 5 5
Specific counselling session 1010 1010 10 1 0 1 0 1 0 1 0 1 0 ! 1 0 10 1 0 1 0 10
MOTHER/BABY CARE POINTS TOTAL
178 MIDWIFERY
Fig. 3 "SNAP' Intervention Statements--Postnatal ward (For use with Form MWMS/MC/1 )
MOTHER GENERAL CARE
Indep/hygiene/diet/bedmade/
obs (vital signs)/general/
postnatal examination
Wash/bath (1 midwife/nurse)
Bath/bed (1 midwife/nurse)
Perineal swabbing
Toilet (midwife/nurse assist)
Catheterisation
Enema/suppositories/
remove catheter
BABY GENERAL CARE
Topping/tailing
Nappy/cot change (midwife/nurse)
Bathing baby (midwife)
Bathing (supervised by midwife)
Eye care
Examine baby/weigh
Bottle feeding supervision
Bottle feeding midwife
Tube feeding
MOTHER AND/OR BABY
OTHER CARE
Breast feeding/assistance
Breast feeding/supervision
Special vital signs Mother
Special vital signs Baby
Post operative care
Oral medication Mother
Oral Medication Baby
Blood sugar Mother
Blood sugar Baby
Neonatal/laboratoryscreen (PKU)
Collection urine/faeces/empty
urine bag
INJECTIONS, i.m./i.v./sc
Intravenous insertion assist/
discontinue
Commence infusion
Change i.v. fluid/blood/care
Aseptic dressing/
change Redivac bottle
EMERGENCY
Cardiac arrest/other
Assist doctor/e.g. VE/any other
Specific counselling session
Strip/remake bed or tidy bed clothes
Instructions to client, e.g. directions to toilet/collecting specimens,
supervising; cleanliness of washing area; checking of water temperature
Presentation of meal/observe dietary intake
Postnatal check/general examination
Includes observation and recording
Assist client to wash in bed or assist in general bath
To attend all purposes of hygiene including catheter care when necessary
Includes examination of perineum
Walk client to toilet/give bedpan/commode
Insertion of catheter/measure/record or assist doctor/measure/record
Includes giving bedpan/commode/record
Includes checking skin/eyes/cord/identification
Includes checking skin/eyes/cord/identification
Includes checking skin/eyes/cord/identification
Includes checking skin/eyes/cord/identification
Includes instructions on eye care/
Includes instil cream/drops/swab
Top to tail
Includes preparation and giving of bottle
Includes preparation and giving of bottle
Includes preparation of feed and recording
Includes preparation of baby and mother
Includes preparation of baby and mother
Includes observation and recording
Includes phototherapy, observation/recording
Includes vital signs/recording
As per West Glamorgan policy
As per West Glamorgan policy
Capillary blood sample: read against BM Stix
Capillary blood sample: read against BM Stix
As per West Glamorgan procedures
Collection/labelling and recording of specimens
Includes disposal and recording
Administering medication via injection--
includes checking drug, identifying client
Includes midwife/nurse assist during insertion of i.v. or discontinuing the
infusion
NOT including i.v. insertion
Includes checking fluid and recording
As per West Glamorgan Practice Manual, based on timing not technicality.
Includes recording
Utilisation of appropriate midwifery/nursing staff
Any assistance given to doctor--includes post operative examination
Comforting of a distressed client; talking about client's/baby's condition
 MIDWIFERY 179

written standards against them, a quality audit
questionnaire, allowed ease of scoring.
The findings indicated that a problem existed
in a very busy clinic where there were a large
number of clients. This was further aggravated
by the indistinct role of midwives and doctors
causing 'bottle necks' in the clinic when doctors
were called away for emergency gynaecological
and obstetric cases. At one clinic there were five
couches being attended concurrently and many
interruptions due to telephone calls. Therefore
quality care was difficult to achieve. Already it is
recommended that:
1) a review of the appointment system be under-
taken along with defining the role of the mid-
wife and the doctor;
2) in the antenatal clinic areas, a long recognised
need to fully utilise midwifery skills is already
being reinforced by this study.
CONCLUSION
This paper has described the preliminary stages
in developing a Midwit~ry Workload Manage-
ment System. The midwifery process provides a
system of defining a quantifiable workload. Care
plans are modified to pick up elements of care.
This involves a training element. The time spent
on the project to date has proved very worth-
while and currently proposals are in hand to pro-
ceed with the study and further data analysis. It
is anticipated that the 'side effect' of enabling
quality care and review of practices will continue
to expand as further recommendations are made
and implemented.
Proposed plan of action
The project has been launched and is already
well advanced. The following stages have been
identifed:
1) Stage I Planning
2) Stage II Formation of Committees
3) Stage III Steering Group
4) Stage VI Working Group
The plan is summarised in Tables 2-5.
The main objective of the initial planning
stage was to gain a commitment from the mid-
wifery staff to developing and using the method
devised in measuring a midwifery workload
management system (MWMS) (Table 2): The
already experienced members of the project
nurse team were able to guide the specialist mid-
wifery working group drawn from across the Dis-
trict Health Authority and also train observers.
During Stages II and I I I , the detailed con-
sideration of midwithry interventions led to a
review of some policies and a decision with
regard to standards of care in different units, so
furthering the constant task of reviewing policy
and practice (Tables 3 & 4). During Stage IV
(Table 5) a detailed consideration of midwifery
care plans has formed an integral part of the study
so that a bonus is already being experienced in

Table 2
Project development/implementation: Stage 1--Planning

Activity Objectives Reasons Implementation Proposed action

1.0 1.1 1.1 1.1 1.2

Stage I To gain a
Planning commitment to
developing and
using the system
The speed and To communicate with a
effectiveness of view to involvement of
installation (system) is professional
directly proportional to organisations, unions
the degree of and the affected
commitment expressed personnel (nursing and
others, e.g. medical and
paramedical)
Policy documents devised as an
exposition of co-operation with
professional organisations,
unions, District Committees.
Particular emphasis to
establishing a working rapport at
ward level
1.2
Scheduled meetings aimed at
developing a two way feedback
of information
180 ,IDWIVERY

Table 3
Project development/implementation: Stage II--Formation committees

Activity Objectives Reasons Implementation Proposed action

2.0 2.1.1 2.1.1 2,1.1 2.1.1

Stage 2 To ensure meetings To interpret District/ Steering Group Inaugural meeting and
Formation of are held at District/ All Wales/Policies to comprise Senior thereafter 3/4 monthly
Committees local (ward)/ meet local needs Midwifery Managers/ meetings
community level Research Midwife/
2.1.2
Project N u rse
Inaugural meeting and
2,1.2 thereafter monthly meetings
Working Group not exceeding 2 hours
representation comprise (Working Groups will overlap
Clinical/Managerial/ according to specialty
Educational/Midwives/ studied)
Project Nurse/Research
Midwife

the careful review and evaluation of individual-
ised care.
Against the identified interventions of mid-
wifery care, a student midwife has a growing con-
tribution. The competency of a student is
dependent on statutory regulations which re-
quire supervision by a qualified midwife. Whilst
the auxiliary nurse is assumed to be giving full
contribution to the work she has been employed
to undertake, as directed by the midwife. This
will be very significant as student midwives
become truly supernumerary in the light of the
U K C C Project 2000 recommendations. Even
though midwifery education will be separate
from nurse education, the educational implica-
tions and service commitment will be similar.
From historical workload information gath-
ered at ward level, the ward midwifery m a n a g e r
is enabled to identify a care skill mix (grades) to
meet the current recommended proposals with
regard to skill mix and clinical gradings. T h e
established criterion which considered individua-
lised m o t h e r / b a b y care has been unequivocably
maintained. However, in areas such as the labour
ward where a midwife is ideally providing care
throughout labour on a one to one basis, this can
preclude her availability to other clients. Sim-
ilarly in the Special Care Baby Unit, the con-
siderable demands made on the high level of
expertise will exclude some midwives or nurses
from contributing to the overall eft~ctive supply.
The proposed implementation of the midwifery

Table 4
Project development/implementation: Stage Ill--Steering Group

Activity Objectives Reasons Implementation Proposed action

3.0 3.1.1 3.1.1 3.1.1 3.1.1

Steering/ To ensure that objective
Working 2.1.1 Stage 2 above meets
Groups with All Wales Nurse
Manpower
recommendations
To organise a working
group and monitor its
progress
To submit a periodic report
to the Chairmen of the
Steering Group/Working
Groups
The All Wales The Project Nurse The Project Nurse will
recommendations provide will act as co- document activities of
the criteria on which to base
ordinator between the Working Group and
the MWMS development the Steering Group/ will ensure that
Senior Midwifery Managers WorkingGroups, to interested parties will
ensure dissemination receive periodic reports
hold responsibility for of information to on progress
professional and managerial various interested
decisions which affect
midwifery personnel
 MIDWIFERY 18 1

Table 5
Project d e v e l o p m e n t / i m p l e m e n t a t i o n : Stage I V - - W o r k i n g Group

Activity Objectives Reasons Implementation Proposed action

4.0 4.1.1 4.1.1 4.1.1 4.1.1

Working To define standards of It is the responsibility of Midwives/N urses To devise/agree standard
Group patient care at various the midwifery profession working in a specialty statements at levels:
levels, i.e.: to establish written area should set the i) District
i) District standards of midwifery standards which must ii) Specialty hospital/
ii) Specialty (hospital/ practice and that these be acceptable to community
community) standards are met at an midwives/nurses iii) Identified interventions
iii) Identified agreed-upon standard working in that area (individual client level)
interventions of care
(individual client/
baby)
4.t .2 4.1.2 4.1.2 4.1.2
To identify types of The system development Project nurse/Research Activity data collected
activity, agree must be "sensitive' to Midwife from:
concensus timings, workload through i) identify activities i) Direct/indirect client
undertake activity 'measured' needs of ii) negotiate timings of care/domestic/admin
sampling study individual client/baby interventions duties etc.
iii) co-ordinate activity ii) Concensus and/or
sampling study scientifically measured
iv) SCI ENTI FICALLY timings of interventions
VALI DATE DATA iii) Activity sampling
COLLECTION study, used in
conjunction with
standards of midwifery
care

w o r k l o a d system is i m m i n e n t . T h e p r e p a r a t o r y Goodbody C, Catterall K 1984 Assessing the Needs for

w o r k of a w a r e n e s s e d u c a t i o n a n d t r a i n i n g of staff
has b e e n u n d e r t a k e n , professional o r g a n i s a t i o n s
and unions informed. A detailed implementation
g u i d e has b e e n devised, a q u a l i t y a s s u r a n c e d o c u -
m e n t will be used s u b s e q u e n t to the a m e n d m e n t s
to the pilot study a n d will w o r k alongside the
system to ensure t h a t m i d w i f e r y p r a c t i c e is
c a r r i e d o u t at an a g r e e d s t a n d a r d by a p p r o p r i a t e
staff at the o p t i m u m time. I n this w a y i n d i v i d u a l -
ised q u a l i t y c a r e s h o u l d be facilitated by the
m a n a g e m e n t of resources to the best a d v a n t a g e
of all c o n c e r n e d .
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