Good managers will often look at other sectors to bring across good ideas and examples of good practice, but could maternity managers learn something from counterparts in the retail sector? Edwin van Teijlingen and Emma Pitchforth investigate.

Although the kind of problems managers face often seem context and industry specific, many problems do not vary that much across different sectors.

This article outlines insights gained from a comparative study of the organisation of the retail sector and the maternity care sector. We use a comparative perspective to analyse developments over the past two or three decades with particular focus on the organisation of maternity care and developments in the retail sector in rural areas of the UK

One key change that rural pregnant women and rural shoppers have in common is the centralisation of services. Over the past few decades many local village post offices, libraries, petrol stations, pubs and community-maternity units have disappeared.  

This change is not simply a centralisation of one service, be it maternity care or retail, from a smaller unit to a larger unit, it is often accompanied by a change of philosophy which in turn will lead to an attitude change. The centralisation of both rural maternity services and shops has resulted in a greater reliance on technology, less personalised service and a focus on economies-of-scale.

Comparing the retail and maternity care sectors

In making a sociological comparison we have distilled, on the one hand, the key characteristics of the small shops and maternity units, and on the other, those of large supermarkets and central obstetric hospitals. 

Maternity care and retail sectors in rural areas: shared characteristics

Supermarket/obstetric unit                   Local shop/rural maternity unit
Offers everything/one-stop shop  Basic service/limited range
Little local identity     Local identity
Less personal/impersonalFamiliar/personalised
Larger/economies of scale Smaller
More technology-focused   More people-focused
Institution-focused      Community-focused
Dominant ideology     Fringe ideology

Focusing on one of these characteristics - “local identity” - the general complaint in the UK is that high streets everywhere look pretty much the same, from Aberdeen to Bournemouth to Cambridge. All have branches of the same banks, coffee shops, fast-food restaurants, opticians etc.

While the large out-of-town supermarkets have been referred to as “big boxes”, more than one study has found women referring to large obstetric hospitals as impersonal “conveyer belt systems”, with midwives “working against the clock” rather than offering personalised care.

Smaller maternity units and shops are based on a different service philosophy; they are more focused on people in their service provision. Less technology-focused, smaller maternity and retail units often find it easier to offer client-centred care. This has also aided the medicalisation of childbirth, with more and more babies now delivered in large hospitals where the chance of an intervention, for example caesarean section, in the birth process is much higher than in smaller, localised birth units.

What does this mean in practical terms?

Steering developments

Perhaps there is something that policy makers in the health service can learn from some of the types of intervention in the retail sector aimed at promoting the growth of local services to keep rural areas alive. Interventions such as limiting planning permission for the building of more large-scale supermarkets, or rural development organisations actively supporting rural Post Offices could be adopted to support rural maternity provision.

A possible third way?

More recently the retail world has seen the growth of medium-sized retail units as branches of multinational food such as Tesco Metro or M&S Food. Policy makers in the health services may want to consider if similar developments are feasible in the organisation of maternity care. At the moment most of the smaller maternity units are down-graded consultant-led maternity unit or stand-alone midwife-led units, is there a place for something not a high-tech as an academic obstetric unit and not as low-tech as a midwife-led unit?

Protest

Expect protest and expect it to be organised. Protests from communities against new supermarket developments and closure of local maternity units have recently achieved scale and publicity. Moreover, in both sectors internet consumer groups have used the internet to exchange information globally whilst supporting protests locally. Any changes and innovation in service organisation of services are likely to attract protest but may be minimised with good community involvement from an early stage.

We are not arguing that “small is always beautiful”, but we are certainly want to make the point that “bigger is not always better”. For more information about this issue our study Rural Maternity Care: Can We Learn From Wal-Mart? has been published in 2010 in the academic journal Health and Place.

Find out more

Rural Maternity Care: Can We Learn From Wal-Mart? Health and Place