gms | German Medical Science

The current staff requirement calculation for midwives working in a delivery ward is based either on revenue or on an arrangement made between the German Hospital Association (Deutsche Krankenhausgesellschaft) and the German Organisation of Midwives (Deutscher Hebammenverband) in 1993 (Plücker 2012). Whereas the first method does not calculate the staff requirement according to the actual need but considers only the revenue, the second method is not binding anymore due to changes in hospital financing. Also, it is based on an out-of-date and unsound data base (Lippert 1990).

A changing midwifery/obstetrics environment in Germany that is characterised by an increasing rate of caesarean sections and other medical interventions (AQUA 2012) needs an up-to-date analysis of the processes which determine midwifery/obstetrics practice in the delivery wards. This analysis is suitable for the development of an appropriate and up-to-date instrument for measuring the staff requirements of German midwives.

This bachelor thesis is part of the research project “Versorgung während Schwangerschaft, Geburt und Wochenbett – Instrumente zur sektorenübergreifenden Qualitätsentwicklung – IsQua” (care during pregnancy, birth and postpartum – instruments for intersectoral quality development) at the University of Applied Sciences Osnabrück and the sub-project “Personalbedarfsermittlung von Hebammen im Kreißsaal” (staff requirement calculation for German midwives working in a delivery ward).

It is planned to do job shadowing in four hospitals, one hospital of each care level (defined levels for newborns in Germany). Each job shadowing will last two weeks. Data will be collected by conducting interviews with experts (Meuser und Nagel 2009) and by non-participant observations. The following research questions will be answered: Which work processes of midwives do exist? How can these processes be defined? What influence do these work processes have on staff requirement?

The project’s goal is to identify, define and allocate specific tasks of midwifery practice via process analysis which is going to be done in the participating hospitals. In the long-term, optimizing of processes by identification and classification of discrete processes might be achieved and thereby an improvement of midwifery care for women in German delivery wards.

First results are going to be presented at the 2nd International Symposium of the DGHWi in Kassel.

The project addresses a current topic of German midwifery practice. Specific tasks of midwifery practice are to be described in order to distinguish those tasks from those of other professionals. It is expected that after job shadowing in the four hospitals, discreet processes will emerge. It is to be seen how well they can be defined and to what extend they can be standardized. Also, it is unclear which processes are transferrable to other hospitals and what influence they do have on the staff requirements.

On one hand, by doing the process analysis and process improvement, the low budget, which is calculated based on the flat rate per case, might be used in an optimal way in the future. Midwives might primarily practice specific midwives’ tasks, other unspecific tasks might be carried out by other employees. On the other hand, this analysis could be a starting point for calculating the actual staff requirements as well as a base for staff requirement calculation (BMI 2007, Gütersloher Organisationsberatung GmbH 2011).