Seven features of safety in maternity units: a framework based on multisite ethnography and stakeholder consultation

Abstract

Background: Reducing avoidable harm in maternity services is a priority globally. As well as learning from mistakes, it is important to produce rigorous descriptions of ‘what good looks like’. Objective: We aimed to characterise features of safety in maternity units and to generate a plain language framework that could be used to guide learning and improvement. Methods: We conducted a multisite ethnography involving 401 hours of non-participant observations 33 semistructured interviews with staff across six maternity units, and a stakeholder consultation involving 65 semistructured telephone interviews and one focus group. Results: We identified seven features of safety in maternity units and summarised them into a framework, named For Us (For Unit Safety). The features include: (1) commitment to safety and improvement at all levels, with everyone involved; (2) technical competence, supported by formal training and informal learning; (3) teamwork, cooperation and positive working relationships; (4) constant reinforcing of safe, ethical and respectful behaviours; (5) multiple problem-sensing systems, used as basis of action; (6) systems and processes designed for safety, and regularly reviewed and optimised; (7) effective coordination and ability to mobilise quickly. These features appear to have a synergistic character, such that each feature is necessary but not sufficient on its own: the features operate in concert through multiple forms of feedback and amplification. Conclusions: This large qualitative study has enabled the generation of a new plain language framework—For Us—that identifies the behaviours and practices that appear to be features of safe care in hospital-based maternity units.

Publication DOI: https://doi.org/10.1136/bmjqs-2020-010988
Divisions: College of Business and Social Sciences > School of Social Sciences & Humanities
College of Business and Social Sciences > School of Social Sciences & Humanities > Sociology and Policy
College of Business and Social Sciences > School of Social Sciences & Humanities > Centre for Critical Inquiry into Society and Culture (CCISC)
Additional Information: © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. Funding: Health Foundation (THIS Institute), Wellcome Trust Senior Investigator Award (WT097899MA) and NIHR Senior Investigator Award (NF- SI-0617-10026).
Uncontrolled Keywords: healthcare quality improvement,obstetrics and gynecology,patient safety,qualitative research,Health Policy
Publication ISSN: 2044-5423
Full Text Link:
Related URLs: https://quality ... jqs-2020-010988 (Publisher URL)
http://www.scop ... tnerID=8YFLogxK (Scopus URL)
PURE Output Type: Article
Published Date: 2021-05-19
Published Online Date: 2020-09-25
Accepted Date: 2020-08-21
Submitted Date: 2020-02-04
Authors: Liberati, Elisa Giulia
Tarrant, Carolyn
Willars, Janet
Draycott, Tim
Winter, Cathy
Kuberska, Karolina
Paton, Alexis (ORCID Profile 0000-0003-4310-6983)
Marjanovic, Sonja
Leach, Brandi
Lichten, Catherine
Hocking, Lucy
Ball, Sarah
Dixon-Woods, Mary
the SCALING Authorship Group
Bevens, Cathy
Brigante, Lia
Brintworth, Kate
Burt, Jenni
Carlile, Carol
Chaffer, Denise
Chakrabarti, Sanhita
Christmas, Tracey
Clark-Ward, Victoria
Clements, Sophie
Crofts, Joanna
Davis, Paul
Deacon, Lesley
Donald, Fiona
Duckett, Rachel
Duffy, James M.N.
Dyson, Charlotte
Edwards, Sian
Farrar, Diane
Fogarty, Matthew
Forrester, Mandy
Fowler, Aidan
Haddon, Richard
Halliday, Robyn
Harmer, Clea
Houghton, Jill
Johnston, Carolyn
Jolly, Matthew
Kaur-Desai, Tejinder
Kelly, Tony
Kirby, Joy
Leslie, Karin
Lewis, Sandy
Lindley, Amanda
Locock, Louise
Lucas, Nuala
Lyndon, Audrey
Mackintosh, Nicola
Matthews, Joanne
McCulloch, Bernadette
McHugh, Siobhan
Merritt, Sarah
Morris, Edward
Nicol, Alison
Patil, Anita
Percival, Rebecca
Pradhan, Farrah
Punch, Daniel
Rowley, Amanda
Roy, Catherine
Russell, Elizabeth
Rzewuska, Magdalena
Simpson, Kathleen
Titcombe, James
Upton, Michele
Walton, Gill
Wells-Munro, Sascha
Wilson, Caitlin
Wilson-Crellin, Rebecca
Wright, Alison
Yau, Christopher

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