title: Early labour services: changes, triggers, monitoring and evaluation.
abstract: OBJECTIVE
  to identify the changes to early labour services, their triggers and monitoring.
  
  
  METHODS
  a mixed methods approach in two stages, firstly a postal questionnaire survey of Heads of Midwifery (HoM) services in NHS Trusts in England (cover sheet to each HoM and questionnaire for each unit in their jurisdiction) and, secondly, semi-structured telephone interviews with a purposive sample of senior midwives. The interviews sought further information about reasons for change; the impact of changes and explored the unit's particular innovations. PARTICIPANTS AND RESPONSE RATE: 145 (89%) NHS Trusts provided data (cover sheet and/or questionnaire); responses were received from all areas and types of unit. Seventeen HoMs or designated senior midwives were interviewed.
  
  
  RESULTS
  83 of 170 units (49%) had made changes to early labour service provision during the past 5 years, including home assessment; the introduction of triage units and telephone assessment tools. Changes were more likely in high volume units and in consultant units with midwifery-led care areas. Further changes were planned by 93/178 (25%) units. Triggers for changes to early labour services comprised local or unit-based factors, including Category X (non-labour) admissions, response to service users and research evidence. The impact of Category X admissions on workload contributed to the triggers for change. Fifty-six (31%) could provide a confirmed figure or estimate for category X admissions. Experiences of introducing change included issues related to engagement of the workforce and the contribution of clinical leadership. Thirty-eight (48%) units did not routinely monitor use of early labour services. Overall monitoring of services was not significantly more likely in units that had made changes. Audit activity was reported more frequently in units that had made changes to their early labour services.
  
  
  CONCLUSIONS
  early labour services had undergone significant changes following a range of triggers but the extent of change was not reflected in monitoring and evaluation activity.
  
  
  CONCLUSIONS
  Changes to service provision should be accompanied by monitoring and evaluation. Changes to services require utilisation of appropriate change management strategies.
authors: School of Nursing, Midwifery and Physiotherapy, University of Nottingham, Medical School, Queen's Medical Centre, Nottingham, UK. helen.spiby@nottingham.ac.uk
authors: Helen
authors: H
authors: Spiby
authors: Josephine M
authors: JM
authors: Green
authors: Helen
authors: H
authors: Richardson-Foster
authors: Clare
authors: C
authors: Hucknall
mesh_terms: D000328:Adult; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007745:Labor Onset; D008427:Maternal Health Services / Q000379:methods / Q000458:organization & administration; D008880:Midwifery / Q000379:methods / Q000458:organization & administration; D009936:Organizational Innovation; D011247:Pregnancy; D036301:Qualitative Research; D011785:Quality Assurance, Health Care; D013222:State Medicine / Q000639:trends*; D011795:Surveys and Questionnaires; D006113:United Kingdom