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

Published version
Peer-reviewed

Change log

Authors

Liberati, Elisa Giulia  ORCID logo  https://orcid.org/0000-0003-4981-1210
Tarrant, Carolyn 
Willars, Janet 
Draycott, Tim 
Winter, Cathy 

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.

Description

Keywords

Original research, 1506, qualitative research, healthcare quality improvement, patient safety, obstetrics and gynecology

Journal Title

BMJ Quality & Safety

Conference Name

Journal ISSN

2044-5415
2044-5423

Volume Title

Publisher

BMJ Publishing Group
Sponsorship
NIHR Senior Investigator Award (NF-SI-0617-10026)
Wellcome Trust Senior Investigator Award (WT097899MA)
Health Foundation (THIS Institute)