TY - JOUR
T1 - Seven features of safety in maternity units
T2 - a framework based on multisite ethnography and stakeholder consultation
AU - The SCALING Authorship Group
AU - Liberati, Elisa Giulia
AU - Tarrant, Carolyn
AU - Willars, Janet
AU - Draycott, Tim
AU - Winter, Cathy
AU - Kuberska, Karolina
AU - Paton, Alexis
AU - Marjanovic, Sonja
AU - Leach, Brandi
AU - Lichten, Catherine
AU - Hocking, Lucy
AU - Ball, Sarah
AU - Dixon-Woods, Mary
AU - Bevens, Cathy
AU - Brigante, Lia
AU - Brintworth, Kate
AU - Burt, Jenni
AU - Carlile, Carol
AU - Chaffer, Denise
AU - Chakrabarti, Sanhita
AU - Christmas, Tracey
AU - Clark-Ward, Victoria
AU - Clements, Sophie
AU - Crofts, Joanna
AU - Davis, Paul
AU - Deacon, Lesley
AU - Donald, Fiona
AU - Duckett, Rachel
AU - Duffy, James M.N.
AU - Dyson, Charlotte
AU - Edwards, Sian
AU - Farrar, Diane
AU - Fogarty, Matthew
AU - Forrester, Mandy
AU - Fowler, Aidan
AU - Haddon, Richard
AU - Halliday, Robyn
AU - Harmer, Clea
AU - Houghton, Jill
AU - Johnston, Carolyn
AU - Jolly, Matthew
AU - Kaur-Desai, Tejinder
AU - Kelly, Tony
AU - Kirby, Joy
AU - Leslie, Karin
AU - Lewis, Sandy
AU - Lindley, Amanda
AU - Locock, Louise
AU - Lucas, Nuala
AU - Lyndon, Audrey
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2021.
PY - 2021/5/19
Y1 - 2021/5/19
N2 - 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.
AB - 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.
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U2 - 10.1136/bmjqs-2020-010988
DO - 10.1136/bmjqs-2020-010988
M3 - Article
C2 - 32978322
AN - SCOPUS:85107084539
SN - 2044-5415
VL - 30
SP - 444
EP - 456
JO - BMJ Quality and Safety
JF - BMJ Quality and Safety
IS - 6
ER -