BACKGROUND:
In high-income countries, the organisation of maternal and newborn care (MNC) is increasingly shaped by efforts to improve integration, continuity, and outcomes. Despite shared goals between stakeholders, considerable variation exists in how integrated MNC is operationalised. This study investigates organisational variation and its underlying mechanisms using a systems thinking approach.

OBJECTIVES:
To explore variations in implemented organisational elements within and between MNC networks and the mechanisms that contribute to these variations.

METHODS:
We performed a comparative case study. We studied seven cases; maternity care networks that differ in their organisational and network characteristics. We applied a mixed methods approach, combining interviews, focus groups and surveys of network board members, healthcare professionals and clients. Organisational elements (e.g. shared intake, multidisciplinary consultation, continuity of care arrangements) were systematically mapped per network. Causal loop diagrams were developed to understand the underlying mechanisms of organisational variation within and between networks. These diagrams were validated by stakeholders from different relevant perspectives.

RESULTS:
Preliminary findings show significant regional differences in implemented organisational elements such as client engagement in the organisation of integrated MNC. The biomedical way of organising care is an important influencing mechanism. Final results, will be presented at the conference. This study will contribute to a better understanding of how organisation of MNC and underlying mechanisms shape provision of integrated MNC.

CONCLUSIONS:
These insights may help overcome barriers to implementing effective elements in integrated MNC, ultimately supporting more sustainable and context-sensitive transformation.

KEY MESSAGE:
Applying systems thinking is expected to provide a deeper understanding of variation in the organisation of integrated MNC and the underlying mechanisms. By constructing causal loop diagrams from multiple stakeholder perspectives, we aim to uncover underlying organisational mechanisms and identify key leverage points. These insights may help overcome barriers to implementing effective elements in integrated MNC, ultimately supporting more sustainable organisation of MNC. Poster session 2 (Group A)