1. Seven features of safety in maternity units: a framework based on multisite ethnography and stakeholder consultation
- Author
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Liberati, Elisa Giulia, Tarrant, Carolyn, Willars, Janet, Draycott, Tim, Winter, Cathy, Kuberska, Karolina, Paton, Alexis, Marjanovic, Sonja, Leach, Brandi, Lichten, Catherine, Hocking, Lucy, Ball, Sarah, Dixon-Woods, Mary, the SCALING Authorship Group, Bevens, Cathy, Brigante, Lia, Brintworth, Kate, Burt, Jenni, Carlile, Carol, Chaffer, Denise, Chakrabarti, Sanhita, Christmas, Tracey, Clark-Ward, Victoria, Clements, Sophie, Crofts, Joanna, Davis, Paul, Deacon, Lesley, Donald, Fiona, Duckett, Rachel, Duffy, James M.N., Dyson, Charlotte, Edwards, Sian, Farrar, Diane, Fogarty, Matthew, Forrester, Mandy, Fowler, Aidan, Haddon, Richard, Halliday, Robyn, Harmer, Clea, Houghton, Jill, Johnston, Carolyn, Jolly, Matthew, Kaur-Desai, Tejinder, Kelly, Tony, Kirby, Joy, Leslie, Karin, Lewis, Sandy, Lindley, Amanda, Locock, Louise, Lucas, Nuala, Lyndon, Audrey, Mackintosh, Nicola, Matthews, Joanne, McCulloch, Bernadette, McHugh, Siobhan, Merritt, Sarah, Morris, Edward, Nicol, Alison, Patil, Anita, Percival, Rebecca, Pradhan, Farrah, Punch, Daniel, Rowley, Amanda, Roy, Catherine, Russell, Elizabeth, Rzewuska, Magdalena, Simpson, Kathleen, Titcombe, James, Upton, Michele, Walton, Gill, Wells-Munro, Sascha, Wilson, Caitlin, Wilson-Crellin, Rebecca, Wright, Alison, Yau, Christopher, Liberati, Elisa Giulia, Tarrant, Carolyn, Willars, Janet, Draycott, Tim, Winter, Cathy, Kuberska, Karolina, Paton, Alexis, Marjanovic, Sonja, Leach, Brandi, Lichten, Catherine, Hocking, Lucy, Ball, Sarah, Dixon-Woods, Mary, the SCALING Authorship Group, Bevens, Cathy, Brigante, Lia, Brintworth, Kate, Burt, Jenni, Carlile, Carol, Chaffer, Denise, Chakrabarti, Sanhita, Christmas, Tracey, Clark-Ward, Victoria, Clements, Sophie, Crofts, Joanna, Davis, Paul, Deacon, Lesley, Donald, Fiona, Duckett, Rachel, Duffy, James M.N., Dyson, Charlotte, Edwards, Sian, Farrar, Diane, Fogarty, Matthew, Forrester, Mandy, Fowler, Aidan, Haddon, Richard, Halliday, Robyn, Harmer, Clea, Houghton, Jill, Johnston, Carolyn, Jolly, Matthew, Kaur-Desai, Tejinder, Kelly, Tony, Kirby, Joy, Leslie, Karin, Lewis, Sandy, Lindley, Amanda, Locock, Louise, Lucas, Nuala, Lyndon, Audrey, Mackintosh, Nicola, Matthews, Joanne, McCulloch, Bernadette, McHugh, Siobhan, Merritt, Sarah, Morris, Edward, Nicol, Alison, Patil, Anita, Percival, Rebecca, Pradhan, Farrah, Punch, Daniel, Rowley, Amanda, Roy, Catherine, Russell, Elizabeth, Rzewuska, Magdalena, Simpson, Kathleen, Titcombe, James, Upton, Michele, Walton, Gill, Wells-Munro, Sascha, Wilson, Caitlin, Wilson-Crellin, Rebecca, Wright, Alison, and Yau, Christopher
- 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.
- Published
- 2021