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Hearns G, Klein MC, Trousdale W, et al. Development of a support tool for complex decision-making in the provision of rural maternity care. Healthc Policy. 2010;5(3):82-96
Hearns, G., Klein, M. C., Trousdale, W., Ulrich, C., Butcher, D., Miewald, C., Lindstrom, R., Eftekhary, S., Rosinski, J., Gómez-Ramírez, O., & Procyk, A. (2010). Development of a support tool for complex decision-making in the provision of rural maternity care. Healthcare policy = Politiques de sante, 5(3), 82-96.
Hearns, Glen, et al. "Development of a support tool for complex decision-making in the provision of rural maternity care." Healthcare policy = Politiques de sante vol. 5,3 (2010): 82-96.
Hearns G, Klein MC, Trousdale W, Ulrich C, Butcher D, Miewald C, Lindstrom R, Eftekhary S, Rosinski J, Gómez-Ramírez O, Procyk A. Development of a support tool for complex decision-making in the provision of rural maternity care. Healthc Policy. 2010 Feb;5(3):82-96. PMID: 21286270; PMCID: PMC2831735.
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Healthc Policy. 2010 Feb;5(3):82-96.

Development of a support tool for complex decision-making in the provision of rural maternity care.

Healthcare policy = Politiques de sante

Glen Hearns, Michael C Klein, William Trousdale, Catherine Ulrich, David Butcher, Christiana Miewald, Ronald Lindstrom, Sahba Eftekhary, Jessica Rosinski, Oralia Gómez-Ramírez, Andrea Procyk

Affiliations

  1. Senior Policy and Decision Analyst, Compass Resource Management, Vancouver, BC.

PMID: 21286270 PMCID: PMC2831735

Abstract

CONTEXT: Decisions in the organization of safe and effective rural maternity care are complex, difficult, value laden and fraught with uncertainty, and must often be based on imperfect information. Decision analysis offers tools for addressing these complexities in order to help decision-makers determine the best use of resources and to appreciate the downstream effects of their decisions.

OBJECTIVE: To develop a maternity care decision-making tool for the British Columbia Northern Health Authority (NH) for use in low birth volume settings.

DESIGN: Based on interviews with community members, providers, recipients and decision-makers, and employing a formal decision analysis approach, we sought to clarify the influences affecting rural maternity care and develop a process to generate a set of value-focused objectives for use in designing and evaluating rural maternity care alternatives.

SETTING: Four low-volume communities with variable resources (with and without on-site births, with or without caesarean section capability) were chosen.

PARTICIPANTS: Physicians (20), nurses (18), midwives and maternity support service providers (4), local business leaders, economic development officials and elected officials (12), First Nations (women [pregnant and non-pregnant], chiefs and band members) (40), social workers (3), pregnant women (2) and NH decision-makers/administrators (17).

RESULTS: We developed a Decision Support Manual to assist with assessing community needs and values, context for decision-making, capacity of the health authority or healthcare providers, identification of key objectives for decision-making, developing alternatives for care, and a process for making trade-offs and balancing multiple objectives. The manual was deemed an effective tool for the purpose by the client, NH.

CONCLUSIONS: Beyond assisting the decision-making process itself, the methodology provides a transparent communication tool to assist in making difficult decisions. While the manual was specifically intended to deal with rural maternity issues, the NH decision-makers feel the method can be easily adapted to assist decision-making in other contexts in medicine where there are conflicting objectives, values and opinions. Decisions on the location of new facilities or infrastructure, or enhancing or altering services such as surgical or palliative care, would be examples of complex decisions that might benefit from this methodology.

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