Implementation of a multi-component strategy to optimise the timing and use of induction of labour: a multiple-methods evaluation.

BACKGROUND: Induction of labour rates are rising worldwide and, in certain contexts, are associated with poorer outcomes for some women and babies. In Australia, the induction rate has increased by 8% to 33% since 2010. At a large regional health service in Victoria, Australia, maternity staff developed a toolkit (guidance document and forms) to improve induction of labour decision-making and processes. AIMS: To evaluate the impact of implementing the induction of labour toolkit to reduce variation in practice and support IOL decision making processes in a single site, regional health service. METHODS: Multiple-method, descriptive study design. Phase 1 - audit of routinely collected perinatal data, 11 months pre- and 11 months post-toolkit implementation; Phase 2 - focus group interview with clinicians. FINDINGS: 1849 women (970 pre-implementation and 879 post-implementation) underwent induction of labour, with no statistically significant difference between groups (970/2571 versus 879/2440, p = 0.212). Toolkit implementation was not associated with significant differences in labour, birth, or neonatal outcomes between groups. Four themes were identified through thematic analysis of the interview data: three related to improved induction of labour practice: 1) consistent information sharing with women and families, 2) embedding best practice, and 3) improved interprofessional collaboration. The final theme reflected the barriers to toolkit adherence: 4) challenges operationalising the process. CONCLUSIONS: Qualitative findings suggest that implementing an induction of labour toolkit that includes evidence-based guidance can support clinicians' practice. Health services need to integrate strategies to support effective implementation of processes and practices, with further evaluation of the implementation and sustainability.