Show simple item record

dc.contributor.authorLiberati, Elisaen
dc.contributor.authorTarrant, Carolynen
dc.contributor.authorWillars, Janeten
dc.contributor.authorDraycott, Timen
dc.contributor.authorWinter, Cathyen
dc.contributor.authorChew, Sarahen
dc.contributor.authorDixon-Woods, Maryen
dc.date.accessioned2019-02-09T00:30:44Z
dc.date.available2019-02-09T00:30:44Z
dc.date.issued2019-02en
dc.identifier.issn0277-9536
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/289050
dc.description.abstractMaternity care continues to be associated with avoidable harm that can result in serious disability and profound anguish for women, their children, and their families, and in high costs for healthcare systems. As in other areas of healthcare, improvement efforts have typically focused either on implementing and evaluating specific interventions, or on identifying the contextual features that may be generative of safety (e.g. structures, processes, behaviour, practices, and values), but the dialogue between these two approaches has remained limited. In this article, we report a positive deviance case study of a high-performing UK maternity unit to examine how it achieved and sustained excellent safety outcomes. Based on 143 hours of ethnographic observations in the maternity unit, 12 semi-structured interviews, and two focus groups with staff, we identified six mechanisms that appeared to be important for safety: collective competence; insistence on technical proficiency; monitoring, coordination, and distributed cognition; clearly articulated and constantly reinforced standards of practice, behaviour, and ethics; monitoring multiple sources of intelligence about the unit’s state of safety; and a highly intentional approach to safety and improvement. These mechanisms were nurtured and sustained through both a specific intervention (known as the PROMPT programme) and, importantly, the unit’s contextual features: intervention and context shaped each other in both direct and indirect ways. The mechanisms were also influenced by the unit’s structural conditions, such as staffing levels and physical environment. This study enhances understanding of what makes a maternity unit safe, paving the way for better design of improvement approaches. It also advances the debate on quality and safety improvement by offering a theoretically and empirically grounded analysis of the interplay between interventions and context of implementation.
dc.format.mediumPrint-Electronicen
dc.languageengen
dc.publisherElsevier Ltd.
dc.rightsAttribution 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectHumansen
dc.subjectFocus Groupsen
dc.subjectSafety Managementen
dc.subjectPregnancyen
dc.subjectQualitative Researchen
dc.subjectAnthropology, Culturalen
dc.subjectObstetrics and Gynecology Department, Hospitalen
dc.subjectMaternal Health Servicesen
dc.subjectHealth Services Researchen
dc.subjectFemaleen
dc.subjectPatient Safetyen
dc.subjectUnited Kingdomen
dc.titleHow to be a very safe maternity unit: An ethnographic study.en
dc.typeArticle
prism.endingPage72
prism.publicationDate2019en
prism.publicationNameSocial science & medicine (1982)en
prism.startingPage64
prism.volume223en
dc.identifier.doi10.17863/CAM.36312
dcterms.dateAccepted2019-01-17en
rioxxterms.versionofrecord10.1016/j.socscimed.2019.01.035en
rioxxterms.versionVoR
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden
rioxxterms.licenseref.startdate2019-02en
dc.contributor.orcidLiberati, Elisa [0000-0003-4981-1210]
dc.contributor.orcidTarrant, Carolyn [0000-0001-7356-5342]
dc.contributor.orcidDixon-Woods, Mary [0000-0002-5915-0041]
dc.identifier.eissn1873-5347
rioxxterms.typeJournal Article/Reviewen
pubs.funder-project-idWellcome Trust (097899/A/11/Z)
pubs.funder-project-idHealth Foundation (unknown)
pubs.funder-project-idHealth Foundation (7763)
cam.orpheus.successThu Jan 30 10:51:33 GMT 2020 - The item has an open VoR version.*
rioxxterms.freetoread.startdate2100-01-01


Files in this item

Thumbnail
Thumbnail

This item appears in the following Collection(s)

Show simple item record

Attribution 4.0 International
Except where otherwise noted, this item's licence is described as Attribution 4.0 International