Thesis (MEd (Human Resource Studies))--University of South Australia, 1997

This research investigated a new community-based model of continuity of care provided collaboratively by a small team of midwives and obstetricians (St George Outreach Maternity Project or STOMP). The study considered whether STOMP improved maternal and neonatal clinical outcomes, resulted in a better experience for women and could be implemented within the current resources of a public teaching hospital in Sydney, Australia. A randomised controlled trial using a Zelen design was used to compare the STOMP model with standard care. One thousand and eighty-nine women were randomly allocated to either the STOMP model or standard hospital-based care. The Zelen design was used to increase the participation of women from non-English speaking backgrounds and to reduce disappointment bias in women allocated to the control group. The results suggest that the model of community-based continuity of care is associated with a lower caesarean section rate, more positive experiences for women and costs less than standard care. There were no differences in the number of medical complications experienced in either group, but more women in the control group were admitted to hospital during the antenatal period. There were four perinatal deaths in each group. Women in the STOMP group reported a higher quality of antenatal care compared with the control group. Women in the STOMP group also reported that the community-based service was accessible and convenient with reduced waiting times for appointments. Women in the STOMP group were more likely to have received adequate information about labour, birth and the postnatal period and felt more 'in control' during labour compared with the control group. Women from both groups reported problems with postnatal care, particularly when provided in the hospital. The study also examined the impact of the STOMP model on women from Chinese and Arabic-speaking backgrounds. The STOMP model appeared to reduce the rate of elective and emergency caesarean section in Chinese-speaking women compared with English-speaking women. Small numbers precluded statistical analysis on these data so the results must be interpreted with caution. Women from Chinese-speaking backgrounds reported receiving insufficient information. The STOMP model improved the provision of information, however Chinese-speaking women still reported inferior experiences. There were also differences in the method of infant feeding. The results indicate that the model provides effective, cost efficient and satisfying maternity care. New models of maternity care can be implemented within current resources when organisations have a strong commitment to change.

The continued development of Facilities Management (FM) as a profession largely depends on it playing a stronger strategic role in the decision-making of organisations. This requires the capability of better understanding the clients' facility needs and requirements, which ultimately means that Facilities Managers must learn about the nature of clients' organisations and their organisational cultures. This study contends that in a project it is the briefing process that provides the greatest opportunity for cultural learning to occur, a process wherein it is important for the actors to converge upon shared understanding of facility needs and requirements. By focusing on culture at a cognitive rather than a behavioural level, this study has specifically attempted to identify the types of knowledge learned during a briefing process, to explore the process of cultural learning and the factors that encourage or impede such learning, and to produce an insight into the process. A hospital partnering project was adopted as a case study for investigating the process of cultural learning during the briefing process. Using Nonaka's (1994) theory of Knowledge Creation, this study portrays the briefing process as one wherein the social processes during briefing facilitate the conversion of tacit and explicit knowledge in a cyclical way. Sackmann's (1991) categorisation of knowledge has been used to analyse the social interactions during briefing by dissecting the different levels of knowledge being shared. In support of the cognitive perspective of learning and the conceptual understanding of culture as mindsets or cognitions, Laukkanen's (1996) Comparative Cause Mapping method was used to measure the cultural learning occurring among members of both the FM and their clients' groups, using an in-depth inquiry into five key concepts during the briefing process. Data was collected longitudinally during the briefing process using real-time observations and semi-structured interviews which maximised the comparative measures of similarities and differences in the Cause Maps depicting cultural learning. This integration of culture, learning, and briefing theories usmg Nonaka's (1994) knowledge creation theory, Sackmann's (1991) categorisation of knowledge, and Laukkanen's (1996) Comparative Cause Mapping method has produced interesting and useful insights into the process of cultural learning during the briefing process within a hospital partnering project. The study has found that significant cultural learning did take place during the briefing process and that partnering projects can present opportunities for this to occur. In particular, it is established that cultural learning is best conceived of as a process of social construction in which individuals, subgroups and groups engage in a collective approach to understanding facility needs and requirements. More specifically, briefing meetings were found to represent contexts for social interactions in which cultural learning took place. This learning occurred in constantly negotiated boundaries and through conflicts and disagreements, with actors competing in a dynamic process of social construction to have their version of understanding of the clients' needs and requirements prevail. The diverse client groups within the hospital context being studied provided a management opportunity for Facility Managers to act as 'mediators', which facilitated cultural learning. Finally, FM technical knowledge was shown to be an important tool for the FM group during the process of cultural learning as the participants negotiated their versions of knowledge.

This research investigated a new community-based model of continuity of care provided collaboratively by a small team of midwives and obstetricians (St George Outreach Maternity Project or STOMP). The study considered whether STOMP improved maternal and neonatal clinical outcomes, resulted in a better experience for women and could be implemented within the current resources of a public teaching hospital in Sydney, Australia. A randomised controlled trial using a Zelen design was used to compare the STOMP model with standard care. One thousand and eighty-nine women were randomly allocated to either the STOMP model or standard hospital-based care. The Zelen design was used to increase the participation of women from non-English speaking backgrounds and to reduce disappointment bias in women allocated to the control group. The results suggest that the model of community-based continuity of care is associated with a lower caesarean section rate, more positive experiences for women and costs less than standard care. There were no differences in the number of medical complications experienced in either group, but more women in the control group were admitted to hospital during the antenatal period. There were four perinatal deaths in each group. Women in the STOMP group reported a higher quality of antenatal care compared with the control group. Women in the STOMP group also reported that the community-based service was accessible and convenient with reduced waiting times for appointments. Women in the STOMP group were more likely to have received adequate information about labour, birth and the postnatal period and felt more 'in control' during labour compared with the control group. Women from both groups reported problems with postnatal care, particularly when provided in the hospital. The study also examined the impact of the STOMP model on women from Chinese and Arabic-speaking backgrounds. The STOMP model appeared to reduce the rate of elective and emergency caesarean section in Chinese-speaking women compared with English-speaking women. Small numbers precluded statistical analysis on these data so the results must be interpreted with caution. Women from Chinese-speaking backgrounds reported receiving insufficient information. The STOMP model improved the provision of information, however Chinese-speaking women still reported inferior experiences. There were also differences in the method of infant feeding. The results indicate that the model provides effective, cost efficient and satisfying maternity care. New models of maternity care can be implemented within current resources when organisations have a strong commitment to change.

Thesis (Ed.D.)--University of Tulsa, 1986. / Bibliography: leaves 95-105.

Thesis (M.A.)--West Virginia University, 2008. / Title from document title page. Document formatted into pages; contains iii, 165 p. : ill. (some col.), col. map. Includes abstract. Includes bibliographical references (p. 160-165).

Thesis (M.D.) -- University of Adelaide, based on a study conducted in the Dept. of Social and Preventive Medicine, Monash University, 1973. / Appendix in back pocket.

Thesis (Ph.D.)--University of Melbourne, Office of Research, 1972. / Typescript (photocopy). Includes bibliographical references (leaves 354-359).

Univ., Diss.--Málaga, 2000.

Thesis (Ph. D.)--University of Sydney, 2005. / Title from title screen (viewed 19 May 2008). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Dept. of Family and Community Health Nursing, Faculty of Nursing. Degree awarded 2005; thesis submitted 2004. Includes bibliographical references. Also available in print form.