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The purpose of this paper is to report on a study investigating the limits of the applicability of the focused factory concept (FFC) in health care. The case setting comes from the Dutch obstetric care system, which is organised by principles in sync with the FFC; the organisation for “simple” pregnancies (independent midwifery practices) is fully separated from that for “complex” pregnancies (obstetric departments in hospitals). The paper investigates the degree of fit between how the Dutch obstetric care system is organised and how it operates (internal fit).

This study analyses one year of patient data from one obstetric hospital department and from one midwifery practice in its immediate geographical proximity. Data were collected regarding the medical condition, consultations, and delivery. These data were used to test the degree to which the obstetric care system operates in line with the FFC; one would expect the midwifery practice to operate as a “line process”, and the obstetric department as a “jobbing process”.

Findings suggest that the Dutch obstetric care sector is designed in line with the FFC, but does not operate accordingly. Root causes for this misalignment can be found in the characteristics of the medical condition of pregnancy.

The fact that the data concern only one region must raise caution for generalisation. However, the fact that medical conditions, which can be assumed to be universal, lead to an intrinsic mismatch between the FFC organisation and medical operational reality, suggests that this paper may have broad implications for theory and practice.

For the Dutch obstetric case system, this paper is one in a series that casts doubts on the sustainability of the two‐tiered system. For obstetric care in general, integrated care seems preferable to the FFC. For health care in general, this paper suggests that caution is required in applying the FFC. Moreover, in OM research for health care, more efforts should be made to understand how medical conditions affect the daily operational processes and, hence, the organisational design.

Most of the studies focusing on the applicability of the FFC look at financial and medical outcomes. This paper is original in that it looks at what drives these outcomes, i.e. the degree of fit between strategy, organisational design and operational performance.

Many organisations, including the Royal College of Obstetricians and Gynaecologists, have recommended increasing the number of hours of consultant obstetric presence in UK National Health Service maternity units to improve patient care. St Mary’s Hospital, Manchester implemented 24-7 consultant presence in September 2014. The paper aims to discuss these issues.

To assess the impact of 24-7 consultant presence upon women and babies, a retrospective review of all serious clinical intrapartum incidents occurring between September 2011 and September 2017 was carried out by two independent reviewers; disagreements in classification were reviewed by a senior Obstetrician. The impact of consultant presence was classified in a structure agreed a priori.

A total of 72 incidents were reviewed. Consultants were directly involved in the care of 75.6 per cent of cases before 24-7 consultant presence compared to 96.8 per cent afterwards. Negative impact due to a lack of consultant presence fell from 22 per cent of the incidents before 24-7 consultant presence to 9.7 per cent after implementation. In contrast, positive impact of consultant presence increased from 14.6 to 32.3 per cent following the introduction of 24-7 consultant presence.

Introduction of 24-7 consultant presence reduced the negative impact caused by a lack of, or delay in, consultant presence as identified by serious untoward incident (SUI) reviews. Consultant presence was more likely to have a positive influence on care delivery.

This is the first assessment of the impact of 24-7 consultant presence on the SUIs in obstetrics.

This paper aims to summarize the radiological interventions that can be used by obstetricians and gynecologists.

E-health systems apply in all hospital sectors in the world; interventional radiology (IR) now includes transcatheter and percutaneous techniques that can be applied to various organ systems, including the female reproductive system and pelvis. Interventional radiologists can now offer many services to obstetricians and gynecologists. With the advent of new procedures and refinement of existing techniques, there are now a number of procedures that can be used to treat both vascular and non-vascular diseases. This review summarizes the radiological interventions that can be used by obstetricians and gynecologists.

This review is intended to help gynecologists and obstetricians understand the role of IR in their specialty. Many valuable vascular and nonvascular interventional services can be provided by radiologists for both obstetric and gynecological indications. Many of these IR procedures are minimally invasive with less risk to the patients.

IR is now being used to treat some conditions encountered in obstetrics and gynecology, in particular, uterine leiomyomas, placenta accreta, postpartum hemorrhage and pelvic congestion syndrome. Moreover, with the help of IR, radiologists can also manage several nonvascular pathologies, including drainage of pelvic abscesses, fallopian tube recanalization, image-guided biopsy and fluid collections involving ovarian lesions. The major challenges faced when performing obstetric IR procedures are reduction of radiation exposure for the patient and fetus and preservation of fertility. This review highlights the role of IR in the treatment of various vascular and nonvascular pathologies encountered in obstetrics and gynecology.

The role of consultant obstetricians is under considerable debate. This has particularly focused on the role of consultants in intrapartum care. The article explores the role of the consultant in delivery suite from the view point of a consultant, a clinical director, a training programme director and a chief executive. These viewpoints determine a range of common themes which mean the duties of consultants over their career lifecycle need to be addressed; the need to expand consultant posts; and the tensions which inevitably occur. The authors believe these need to be addressed because of the need to ensure consultant roles in delivery suite are developed as a key part of seeing quality improvement.

The purpose of this paper is to investigate inter-organizational designs for care–cure conditions in which low-risk patients are cared for in specialized care organizations and high-risk patients are cared for in specialized cure organizations. Performance impacts of increasing levels of integration between these organizations are analyzed.

Mixed methods were used in Dutch perinatal care: analysis of archival data, clinical research and system dynamics simulation modeling.

Inter-organizational design has an effect on inter-organizational dynamics such as collaboration and trust, and also on the operational aspects such as patient flows through the system. Solutions are found in integrating care and cure organizations. However, not all levels of integrated designs perform better than a design based on organizational separation of care and cure.

A clear split between midwifery practices (care) and obstetric departments (cure) will not work since all pregnant women need both care and cure. Having midwifery practices only works well when there are high levels of collaboration and trust with obstetric departments in hospitals. Integrated care designs are likely to exhibit superior performance. However, these designs will have an adverse effect on organizations that are not part of this integration, since integrating only a subset of organizations will feed distrust, low collaboration and hence low performance.

The originality of this research is derived from its multi-method approach. Archival data and clinical research revealed the dynamic relations between organizations. The caveat of some integrated care models was found through simulation.

Instrumental vaginal delivery is an area often responsible for indefensible claims. One of the important reasons for this is poor medical record keeping. The standard of record keeping for instrumental vaginal deliveries within our unit was audited with a view to improving deficiencies. A retrospective analysis of 100 case records of women having an instrumental vaginal delivery was made over a period of one year. After identifying deficiencies in the quality of record keeping a pre‐printed standard record form was introduced and a further 50 cases audited. Deficiencies were identified in the documentation of clinical obstetric findings, type of anaesthesia, estimated blood loss, type and size of ventouse cup used. Analysis of cases using the standard record form has demonstrated 100 percent compliance with adequate record keeping.

The success ofThe need to develop a consultant presence on the delivery suite has never been greater given the emerging quality agenda that is occurring within the speciality. This is identifying a clear impetus for changing consultant practice and also meeting the needs of women more effectively. The article describes these trends, the impetus for change and identifies practically how such a change was achieved within the largest women’s hospital in the UK. It defines the basis for building a vision for an improved future and the practical use of management and transformational leadership skills to change consultant behaviour and attitudes with a clear set of outcomes that were achieved.

The paper seeks to examine how an online maternity record involving pregnant women worked as a means to create shared maternity care.

Ethnographic techniques have been used. The paper adopts a theoretical/methodological framework based on science and technology studies.

The paper shows how a version of “the responsible patient” emerges from the project which is different from the version envisioned by the project organisation. The emerging one is concerned with the boundary between primary and secondary sector care, and not with the boundary between home and clinic, which the project identifies as problematic and seeks to transgress.

The pilot project, which is used as a case, is terminated prematurely. However, this does not affect the fact that more attention should be paid to the specific redistribution of responsibilities entailed in shared care projects. Rather than seeking to connect all actors in an unbounded space, shared care might instead suggest a space for patients and professionals to experiment with new roles and responsibilities.

When designing coordination tools for health care, IT designers and project managers should attend to the specific ways in which boundaries are inevitably enacted and to the ways in which care is already shared. This will provide them with opportunities to use the potentials of new identities and concerns that emerge from changing the organisation of healthcare in relation to IT design.

The paper shows that “unshared” care does not exist; care is always shared among human and nonhuman actors. It also points to the value of studying how boundaries are enacted in projects that seek to create continuity across boundaries.

The purpose of this paper is to determine if recommendations from the General Medical Council (GMC), Royal College of Obstetricians and Gynaecologists (RCOG) and Ayling Inquiry with regard to chaperoning are observed in the hospital setting by consultants performing intimate physical examinations, and to ascertain consultants' views on the availability, nature and role of chaperones.

A quantitative postal questionnaire was carried out based on the GMC and RCOG recommendations, and point 2.58 of the Ayling Inquiry. Participants were all consultants specialising in obstetrics and gynaecology, colorectal surgery, breast surgery, urology, genito‐urinary medicine, and paediatrics in York and West Yorkshire Hospitals. The questionnaire covered consultant practice and views on the role of chaperones for intimate physical examinations.

A response rate of 70 per cent was achieved. All gynaecologists, paediatricians, urologists, colorectal surgeons and genito‐urinary physicians request a chaperone when performing female intimate examinations. A total 90 per cent of genito‐urinary physicians request a chaperone compared to only 39 per cent of colorectal surgeons and 28 per cent of urologists for male intimate examinations. Of the consultants 97 per cent reported that a chaperone was “always” or “usually” available. A total 94 per cent considered health‐care professionals to be appropriate chaperones. Cited roles of a chaperone include doctor protection (93 per cent), patient protection (84 per cent), patient comfort (73 per cent), and medico‐legality (72 per cent). Only 20 per cent of consultants stated they document the presence of a chaperone.

The paper reveals that consultants use a chaperone for all female genital examinations, but inter‐speciality differences exist for male intimate examinations in spite of national recommendations. A minority of consultants document the presence of a chaperone for intimate examinations. Consultants consider health‐care professionals to be the most appropriate chaperones, and believe chaperones add to patient comfort and protect both doctor and patient.

This paper engaged in theory-building from social movement and knowledge management (KM) theories and applied the case study method to explore the role of knowledge complexity in administration–society collaborations on knowledge. Complex knowledge is a kind of knowledge that consists of many interdependent elements, some of which are tacit. Complex knowledge creates challenges when external social groups attempt to transfer their knowledge to public organizations. Thus, the purpose of this paper is to investigate the following question: how do social groups acting as knowledge agents transfer their knowledge if it is complex?

A single-case study methodology informs the theory-building in this paper. The paper examined a case of collaboration between the natural childbirthing social movement and state maternity hospitals in Russia and Ukraine. The case was constructed from interviews, primary sources and secondary sources.

Social movement and KM theories were used in a case analysis to formulate theoretical propositions about the complexity of social movement knowledge, why and how movements transfer their knowledge through collaborations with the state, and how administrators assess movement knowledge and its transfer. The case suggests that administrators’ lack of capacity to recognize and deal with complex knowledge results in the underutilization of social groups’ knowledge. In particular, administrators treat complex knowledge as simple, and they misunderstand and underestimate its effects on collaboration.

To the best of this author’s knowledge, this paper is the first attempt in public administration to engage in theory-building from social movement and KM theories.