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

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Liberati, Elisa Giulia  ORCID logo
Tarrant, Carolyn 
Willars, Janet 
Draycott, Tim 
Winter, Cathy 

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.

healthcare quality improvement, obstetrics and gynecology, patient safety, qualitative research, Anthropology, Cultural, Female, Focus Groups, Humans, Pregnancy, Qualitative Research, Referral and Consultation
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BMJ Qual Saf
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Wellcome Trust (097899/Z/11/Z)
Health Foundation (unknown)
Health Foundation (7763)
Department of Health (via National Institute for Health Research (NIHR)) (NF-SI-0617-10026)
The 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).