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

Elisa Giulia Liberati; Carolyn Tarrant; Janet Willars; Tim Draycott; Cathy Winter; Karolina Kuberska; Alexis Paton; Sonja Marjanovic; Brandi Leach; Catherine Lichten; Lucy Hocking; Sarah Ball; Mary Dixon-Woods; the SCALING Authorship Group; Cathy Bevens; Lia Brigante; Kate Brintworth; Jenni Burt; Carol Carlile; Denise Chaffer; Sanhita Chakrabarti; Tracey Christmas; Victoria Clark-Ward; Sophie Clements; Joanna Crofts; Paul Davis; Lesley Deacon; Fiona Donald; Rachel Duckett; James M.N. Duffy; Charlotte Dyson; Sian Edwards; Diane Farrar; Matthew Fogarty; Mandy Forrester; Aidan Fowler; Richard Haddon; Robyn Halliday; Clea Harmer; Jill Houghton; Carolyn Johnston; Matthew Jolly; Tejinder Kaur-Desai; Tony Kelly; Joy Kirby; Karin Leslie; Sandy Lewis; Amanda Lindley; Louise Locock; Nuala Lucas; Audrey Lyndon; Nicola Mackintosh; Joanne Matthews; Bernadette McCulloch; Siobhan McHugh; Sarah Merritt; Edward Morris; Alison Nicol; Anita Patil; Rebecca Percival; Farrah Pradhan; Daniel Punch; Amanda Rowley; Catherine Roy; Elizabeth Russell; Magdalena Rzewuska; Kathleen Simpson; James Titcombe; Michele Upton; Gill Walton; Sascha Wells-Munro; Caitlin Wilson; Rebecca Wilson-Crellin; Alison Wright; Christopher Yau

doi:10.1136/bmjqs-2020-010988

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

Elisa Giulia Liberati
, Carolyn Tarrant
, Janet Willars
, Tim Draycott
, Cathy Winter
, Karolina Kuberska
, Alexis Paton
, Sonja Marjanovic
, Brandi Leach
, Catherine Lichten
, Lucy Hocking
, Sarah Ball
, Mary Dixon-Woods^*
, the SCALING Authorship Group
, Cathy Bevens
, Lia Brigante
, Kate Brintworth
, Jenni Burt
, Carol Carlile
, Denise Chaffer

Sanhita Chakrabarti, Tracey Christmas, Victoria Clark-Ward, Sophie Clements, Joanna Crofts, Paul Davis, Lesley Deacon, Fiona Donald, Rachel Duckett, James M.N. Duffy, Charlotte Dyson, Sian Edwards, Diane Farrar, Matthew Fogarty, Mandy Forrester, Aidan Fowler, Richard Haddon, Robyn Halliday, Clea Harmer, Jill Houghton, Carolyn Johnston, Matthew Jolly, Tejinder Kaur-Desai, Tony Kelly, Joy Kirby, Karin Leslie, Sandy Lewis, Amanda Lindley, Louise Locock, Nuala Lucas, Audrey Lyndon, Nicola Mackintosh, Joanne Matthews, Bernadette McCulloch, Siobhan McHugh, Sarah Merritt, Edward Morris, Alison Nicol, Anita Patil, Rebecca Percival, Farrah Pradhan, Daniel Punch, Amanda Rowley, Catherine Roy, Elizabeth Russell, Magdalena Rzewuska, Kathleen Simpson, James Titcombe, Michele Upton, Gill Walton, Sascha Wells-Munro, Caitlin Wilson, Rebecca Wilson-Crellin, Alison Wright, Christopher Yau

^*Corresponding author for this work

THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care , University of Cambridge , Cambridge , Cambridgeshire , UK
Department of Health Sciences , University of Leicester , Leicester , Leicestershire , UK
Department of Translational Health Sciences , University of Bristol , Bristol , UK; PROMPT Maternity Foundation , Bristol , UK
PROMPT Maternity Foundation , Bristol , UK
THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care , University of Cambridge , Cambridge , Cambridgeshire , UK; RAND Europe , Cambridge , Cambridgeshire , UK
RAND Europe , Cambridge , Cambridgeshire , UK

Research output: Contribution to journal › Article › peer-review

47 Citations (SciVal)

36 Downloads (Pure)

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.

Original language	English
Pages (from-to)	444-456
Number of pages	13
Journal	BMJ Quality and Safety
Volume	30
Issue number	6
Early online date	25 Sept 2020
DOIs	https://doi.org/10.1136/bmjqs-2020-010988
Publication status	Published - 19 May 2021

Bibliographical note

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

Funding: Health Foundation (THIS Institute), Wellcome Trust
Senior Investigator Award (WT097899MA) and NIHR Senior
Investigator Award (NF- SI-0617-10026).

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

healthcare quality improvement
obstetrics and gynecology
patient safety
qualitative research

Access to Document

10.1136/bmjqs-2020-010988Licence: CC BY 3.0

bmjqs-2020-010988.full
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.
Final published version, 320 KBLicence: CC BY 3.0

Cite this

Liberati, E. G., Tarrant, C., Willars, J., Draycott, T., Winter, C., Kuberska, K., Paton, A., Marjanovic, S., Leach, B., Lichten, C., Hocking, L., Ball, S., Dixon-Woods, M., the SCALING Authorship Group, Bevens, C., Brigante, L., Brintworth, K., Burt, J., Carlile, C., ... Yau, C. (2021). Seven features of safety in maternity units: a framework based on multisite ethnography and stakeholder consultation. BMJ Quality and Safety, 30(6), 444-456. https://doi.org/10.1136/bmjqs-2020-010988

@article{15fa5e188ac54a38a4767d2fb7d581c1,

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

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 {\textquoteleft}what good looks like{\textquoteright}. 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.",

keywords = "healthcare quality improvement, obstetrics and gynecology, patient safety, qualitative research",

author = "Liberati, \{Elisa Giulia\} and Carolyn Tarrant and Janet Willars and Tim Draycott and Cathy Winter and Karolina Kuberska and Alexis Paton and Sonja Marjanovic and Brandi Leach and Catherine Lichten and Lucy Hocking and Sarah Ball and Mary Dixon-Woods and \{the SCALING Authorship Group\} and Cathy Bevens and Lia Brigante and Kate Brintworth and Jenni Burt and Carol Carlile and Denise Chaffer and Sanhita Chakrabarti and Tracey Christmas and Victoria Clark-Ward and Sophie Clements and Joanna Crofts and Paul Davis and Lesley Deacon and Fiona Donald and Rachel Duckett and Duffy, \{James M.N.\} and Charlotte Dyson and Sian Edwards and Diane Farrar and Matthew Fogarty and Mandy Forrester and Aidan Fowler and Richard Haddon and Robyn Halliday and Clea Harmer and Jill Houghton and Carolyn Johnston and Matthew Jolly and Tejinder Kaur-Desai and Tony Kelly and Joy Kirby and Karin Leslie and Sandy Lewis and Amanda Lindley and Louise Locock and Nuala Lucas and Audrey Lyndon and Nicola Mackintosh and Joanne Matthews and Bernadette McCulloch and Siobhan McHugh and Sarah Merritt and Edward Morris and Alison Nicol and Anita Patil and Rebecca Percival and Farrah Pradhan and Daniel Punch and Amanda Rowley and Catherine Roy and Elizabeth Russell and Magdalena Rzewuska and Kathleen Simpson and James Titcombe and Michele Upton and Gill Walton and Sascha Wells-Munro and Caitlin Wilson and Rebecca Wilson-Crellin and Alison Wright and Christopher Yau",

note = "{\textcopyright} Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. Funding: Health Foundation (THIS Institute), Wellcome Trust Senior Investigator Award (WT097899MA) and NIHR Senior Investigator Award (NF- SI-0617-10026).",

year = "2021",

month = may,

day = "19",

doi = "10.1136/bmjqs-2020-010988",

language = "English",

volume = "30",

pages = "444--456",

journal = "BMJ Quality and Safety",

issn = "2044-5415",

publisher = "BMJ Publishing Group",

number = "6",

}

Liberati, EG, Tarrant, C, Willars, J, Draycott, T, Winter, C, Kuberska, K, Paton, A, Marjanovic, S, Leach, B, Lichten, C, Hocking, L, Ball, S, Dixon-Woods, M, the SCALING Authorship Group, Bevens, C, Brigante, L, Brintworth, K, Burt, J, Carlile, C, Chaffer, D, Chakrabarti, S, Christmas, T, Clark-Ward, V, Clements, S, Crofts, J, Davis, P, Deacon, L, Donald, F, Duckett, R, Duffy, JMN, Dyson, C, Edwards, S, Farrar, D, Fogarty, M, Forrester, M, Fowler, A, Haddon, R, Halliday, R, Harmer, C, Houghton, J, Johnston, C, Jolly, M, Kaur-Desai, T, Kelly, T, Kirby, J, Leslie, K, Lewis, S, Lindley, A, Locock, L, Lucas, N, Lyndon, A, Mackintosh, N, Matthews, J, McCulloch, B, McHugh, S, Merritt, S, Morris, E, Nicol, A, Patil, A, Percival, R, Pradhan, F, Punch, D, Rowley, A, Roy, C, Russell, E, Rzewuska, M, Simpson, K, Titcombe, J, Upton, M, Walton, G, Wells-Munro, S, Wilson, C, Wilson-Crellin, R, Wright, A & Yau, C 2021, 'Seven features of safety in maternity units: a framework based on multisite ethnography and stakeholder consultation', BMJ Quality and Safety, vol. 30, no. 6, pp. 444-456. https://doi.org/10.1136/bmjqs-2020-010988

TY - JOUR

T1 - Seven features of safety in maternity units: a framework based on multisite ethnography and stakeholder consultation

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 - the SCALING Authorship Group,

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

AU - Mackintosh, Nicola

AU - Matthews, Joanne

AU - McCulloch, Bernadette

AU - McHugh, Siobhan

AU - Merritt, Sarah

AU - Morris, Edward

AU - Nicol, Alison

AU - Patil, Anita

AU - Percival, Rebecca

AU - Pradhan, Farrah

AU - Punch, Daniel

AU - Rowley, Amanda

AU - Roy, Catherine

AU - Russell, Elizabeth

AU - Rzewuska, Magdalena

AU - Simpson, Kathleen

AU - Titcombe, James

AU - Upton, Michele

AU - Walton, Gill

AU - Wells-Munro, Sascha

AU - Wilson, Caitlin

AU - Wilson-Crellin, Rebecca

AU - Wright, Alison

AU - Yau, Christopher

N1 - © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. Funding: Health Foundation (THIS Institute), Wellcome Trust Senior Investigator Award (WT097899MA) and NIHR Senior Investigator Award (NF- SI-0617-10026).

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.

KW - healthcare quality improvement

KW - obstetrics and gynecology

KW - patient safety

KW - qualitative research

UR - https://qualitysafety.bmj.com/content/early/2020/09/25/bmjqs-2020-010988

UR - https://www.scopus.com/pages/publications/85107084539

U2 - 10.1136/bmjqs-2020-010988

DO - 10.1136/bmjqs-2020-010988

M3 - Article

C2 - 32978322

SN - 2044-5415

VL - 30

SP - 444

EP - 456

JO - BMJ Quality and Safety

JF - BMJ Quality and Safety

IS - 6

ER -

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

Abstract

Bibliographical note

UN SDGs

Keywords

Access to Document

Other files and links

Fingerprint

Cite this