King's College London

A new study evaluates the decision-making processes of maternity healthcare professionals during the COVID-19 pandemic, as one part of a broader project to evaluate the pandemic’s impact on maternity care services reconfiguration, and how it can recover in its wake to be more resilient against future health shocks.

Published in BMC Pregnancy and Childbirth, the study explores the impact of the COVID-19 pandemic on the decisions healthcare professionals made by maternity services. Sergio A. Silverio led the team in obtaining data from a hospital in South London throughout 2020 by interviewing maternity care staff.

Responses highlighted both positive and negative aspects of their experience as maternity healthcare workers described how they used three types of decision-making paradigms to navigate the pandemic.

‘Reflective decision-making’ was found to have provided unique opportunities to improve the care provided. This encompassed various practices of staff empowerment including flexible working patterns (both on individual and collective level) as well as more personalised care delivery for patients.

‘Pragmatic decision-making’ was also identified by the authors, referring to decisions and practices undertaken as a necessity due to the nature of the pandemic. This included COVID-19 protection measures like social distancing, P.P.E and masks, and minimal contact with patients.

Though workers understood the importance of these measures, they were concerned about their impact on the service and care they could provide. One example was the increased difficulty in establishing a rapport with patients due to social distancing.

In contrast, workers talked about how ‘Reactive decision-making’ within healthcare, like the rapid changes to guidelines and the mixed information in protecting against COVID-19, resulted in significant issues and the devaluation of maternity care.

The authors argue that the benefits provided by reflective and pragmatic decision-making during the pandemic period could be key to a successful re-build in a post-pandemic climate. This would include incorporating the various innovations which arose from reflective decision-making during the pandemic, as well as utilising a pragmatic decision-making framework that has a greater focus on minimising disruption to care.

Alongside these specific recommendations for a post-pandemic recovery of maternity care, the authors hope that developing this analysis of decision-making can provided a general framework for our health systems which helps healthcare professionals and policymakers navigate future crises.

The team are now conducting similar analyses in children’s healthcare to see whether similar patterns are shown in other healthcare services. Further work from this project on race issues amongst women and children’s healthcare professionals and maternity care precarity and preparedness has also been published; as has work with women on their perceptions of care and on their psycho-social experiences.