Abstract:

Purpose
Service operations within safety-critical contexts are characterised by tensions between reliability, standardisation, and responsiveness under conditions of uncertainty. While operational performance is commonly assessed through efficiency and clinical outcomes, less attention has been directed toward experiential quality outcomes that reflect how designed pathways are enacted in practice. This study conceptualises autonomy as an experiential quality performance indicator and examines how its distribution varies across aligned and escalated operational pathways within UK maternity services.

Design/methodology/approach
Drawing on a national survey of over 800 service users, this mixed-method study integrates narrative pattern analysis with quantitative testing. Qualitative analysis identified patterns of sustained and fragmented autonomy across different birth trajectories. To examine these patterns quantitatively, outcomes were grouped into aligned pathways (spontaneous vaginal birth, planned caesarean, induction resolving vaginally, and planned epidural birth) and escalated pathways (induction resulting in unplanned caesarean, emergency caesarean, and unplanned assisted birth). Autonomy was dichotomised as sustained (“Yes, always”) versus low (“Rarely” or “Not at all”), and chi-square analysis assessed association.

Findings
Sustained autonomy was reported in 90% of aligned pathways compared to 64% of escalated pathways (χ²(1, N = 518) ≈ 49, p < .001; Cramér’s V ≈ .31), indicating a moderate association between pathway alignment and perceived autonomy. Planned caesarean birth demonstrated comparatively high levels of sustained autonomy, suggesting that intervention intensity alone does not account for experiential variation. Rather, autonomy appears associated with deviation from anticipated process trajectories and disruptions in expectation alignment during escalation.

Originality/value
By positioning autonomy as an experiential quality performance metric linked to pathway design integrity, the study engages service operations scholarship in examining how process alignment shapes frontline agency in safety-critical service systems. The findings contribute to discussions within Operations and Supply Chain Management concerning the integration of technical reliability and experiential quality in complex service environments.

Please choose your submission type: Full Paper

Primary Track: Operations, Logistics and Supply Chain Management

Keywords: Operations;Operations: public sector;Operational Decision-making

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Mrs. Cheyne Wooderson