Äitiysneuvolapalvelut ja äitiyshuollon innovaatioiden kehittäminen

The purpose of the study is to describe the quality (structures, processes, outcomes) of municipal maternity care and the views of healthcare professionals on both the organisation and development of services in municipalities in mainland Finland in 2008. An example case for the development of need-based innovations within maternity care is also described. This provides new perspectives for the need-based development of services. All 398 municipalities in mainland Finland were targeted in the empirical part of the study. The municipal level response rate was 79% (n=313). Municipalities were classified according to how maternity counseling was organized and municipality-specific results were combined with birth registry data. The data was analyzed using quantitative and qualitative methods. According to the research findings, maternity services were patchy in 2008. The quality of clinical pathways for pregnant women in need of special support should be developed to ensure uniform services, and the organization of services should be reformed into functional entities. According to the views of doctors, public health nurses, midwives and managers, the strength of maternity services was the multidisciplinary, multi-professional collaboration, as well as experienced and knowledgeable professionals. Perceptions of weaknesses in services were related to inadequate skills, including the effects of low birth rates on sustaining skills. The main challenges of referral feedback practices were related to non-uniform information systems and obscure processes. Therefore, the development of maternity services should take better account of the use of specialized medical expertise and midwifery skills, the development of family-oriented processes and multiprofessional cooperation between primary care, social services and specialized medical care. The application of the Biodesign model as a systematic, phased model could be used to develop new, innovative and need-based service innovations for maternity care. The theoretical part of the study describes the principles of design research, so that the Solving the Mesh -case and its progression, is presented according to the phases of the Biodesign process, therefore combining an example with the development of need-based innovations. The results of the study can be used to develop and monitor services that cross traditional organizational boundaries. Maternity services would benefit from centralized guidance, a convergent nationwide system, midwifery competence, centralization of physician expertise, and consistent monitoring to ensure the quality of services and to reduce customer inequality. The needs-oriented development of operations gives the Biodesign process a systematic structure in which the expertise of multi-professional teams can be utilized in the development of innovative service structures.