Reconfiguring Maternity Care? Reflections on two Change Initiatives

This dissertation constitutes a reflection on two initiatives seeking to reconfigure
maternity care. One initiative sought to digitalise maternity records and included
a pilot run of an electronic maternity record in a Danish county. The other consisted
of a collaboration between a maternity ward at a hospital and a group of
researchers which included me. Both initiatives involved numerous seemingly
different interests that were held together and related to reconfiguring maternity
care. None of the initiatives can unequivocally be labelled a success, as neither
managed to change maternity care, at least not in the intended manner. It was,
however, an achievement to relate the different interests for a period. In this
dissertation I will elucidate the proposed changes in the initiatives as well as
expound on the manner in which they were proposed. It is argued that the different
interests involved in the initiatives were not obstacles which the proposed
changes should overcome, but are on the contrary necessary, as it is the alliances
between the particular interests and the proposed changes that motor the initiatives.
The interests were not invented through the initiatives but are formed
through history. Although the two initiatives were different, some of the interests
involved are exercised through the same kinds of logic. The word logic is
used in a particular sense, which is different from the philosophical discipline
bearing the same name. Rather, logic in this dissertation is about modes of acting,
where different logics enable certain actions and make other actions less
likely. The three logics studied are The Logic of Centring the Citizen, Patient and Pregnant
Women, The Logic of Seeking Progress through IT and The Logic of Standardising
through Externalisation. Engaging with the contingent processes forming the three
logics approaches the question why the particular interests managed to contribute
to the initiatives. As the ambitions stated in the initiatives were not realised
it is not possible portray the consequences and politics of the proposed changes
without merely speculating. Although the initiatives were not successful the
ambitions remained. To approach the consequences and politics of the proposed
changes an experiment is instead carried out. This experiment draws on
the interests involved in the initiatives and the three logics, while it constructs a
conceptual frame within which three experimental designs are constructed. The
consequences and the politics of the proposed changes are engaged with in
laboratory manner through collaborative development of the designs and
through exposing them to members of field of maternity care