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dc.contributor.authorLiberati, Elisa
dc.contributor.authorTarrant, Carolyn
dc.contributor.authorWillars, Janet
dc.contributor.authorDraycott, Tim
dc.contributor.authorWinter, Cathy
dc.contributor.authorKuberska, Karolina
dc.contributor.authorPaton, Alexis
dc.contributor.authorMarjanovic, Sonja
dc.contributor.authorLeach, Brandi
dc.contributor.authorLichten, Catherine
dc.contributor.authorHocking, Lucy
dc.contributor.authorBall, Sarah
dc.contributor.authorDixon-Woods, Mary
dc.contributor.authorSCALING Authorship Group
dc.date.accessioned2020-09-22T23:30:59Z
dc.date.available2020-09-22T23:30:59Z
dc.date.issued2021-06
dc.identifier.issn2044-5415
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/310600
dc.description.abstractBACKGROUND: 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.
dc.description.sponsorshipThe first phase of data collection and analysis of the data for this paper was supported by Mary Dixon-Woods’ Wellcome Trust Senior Investigator Award (WT097899MA). The SCALING study, funded by the Health Foundation, supported the second phase of data collection and analysis. MDW, EGL, and KK are supported by the Health Foundation’s grant to the University of Cambridge for The Healthcare Improvement Studies (THIS) Institute. THIS Institute is supported by the Health Foundation — an independent charity committed to bringing about better health and health care for people in the UK. MDW is a National Institute for Health Research (NIHR) Senior Investigator (NF-SI-0617-10026).
dc.format.mediumPrint-Electronic
dc.languageeng
dc.publisherBMJ
dc.rightsAll rights reserved
dc.subjectSCALING Authorship Group
dc.subjectHumans
dc.subjectFocus Groups
dc.subjectPregnancy
dc.subjectQualitative Research
dc.subjectAnthropology, Cultural
dc.subjectReferral and Consultation
dc.subjectFemale
dc.titleSeven features of safety in maternity units: a framework based on multisite ethnography and stakeholder consultation.
dc.typeArticle
prism.endingPage456
prism.issueIdentifier6
prism.publicationDate2021
prism.publicationNameBMJ Qual Saf
prism.startingPage444
prism.volume30
dc.identifier.doi10.17863/CAM.57697
dcterms.dateAccepted2020-08-21
rioxxterms.versionofrecord10.1136/bmjqs-2020-010988
rioxxterms.versionAM
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.licenseref.startdate2021-06
dc.contributor.orcidLiberati, Elisa [0000-0003-4981-1210]
dc.contributor.orcidKuberska, Karolina [0000-0002-9610-1863]
dc.contributor.orcidDixon-Woods, Mary [0000-0002-5915-0041]
dc.identifier.eissn2044-5423
rioxxterms.typeJournal Article/Review
pubs.funder-project-idWellcome Trust (097899/Z/11/Z)
pubs.funder-project-idHealth Foundation (unknown)
pubs.funder-project-idHealth Foundation (7763)
pubs.funder-project-idDepartment of Health (via National Institute for Health Research (NIHR)) (NF-SI-0617-10026)
cam.issuedOnline2020-09-25
cam.orpheus.successTue Oct 06 10:23:43 BST 2020 - Embargo updated
rioxxterms.freetoread.startdate2020-09-25


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