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How to be a very safe maternity unit: An ethnographic study.
Elisa G Liberati1, Carolyn Tarrant2, Janet Willars2
1THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, UK.
Social Science & Medicine (1982)
|February 3, 2019
Summary
High-performing maternity units achieve safety through six key mechanisms, blending specific interventions like the PROMPT programme with contextual factors. This positive deviance study reveals how these elements interact to improve patient safety.
Area of Science:
- Healthcare Improvement Science
- Patient Safety Research
- Maternal Health Services
Background:
- Maternity care faces challenges with avoidable harm, leading to significant distress and high healthcare costs.
- Improvement efforts often focus narrowly on interventions or context, with limited dialogue between the two approaches.
Purpose of the Study:
- To investigate how a high-performing UK maternity unit achieved and sustained excellent safety outcomes.
- To identify the mechanisms contributing to superior safety performance in maternity care.
Main Methods:
- A positive deviance case study of a high-performing UK maternity unit.
- Ethnographic observations (143 hours), semi-structured interviews (12), and focus groups with staff (2).
Main Results:
- Six key safety mechanisms were identified: collective competence, technical proficiency, coordinated monitoring, reinforced standards, safety intelligence monitoring, and intentional improvement.
- These mechanisms were sustained by the PROMPT programme intervention and the unit's specific context, with mutual shaping occurring.
- Structural conditions like staffing and environment also influenced these safety mechanisms.
Conclusions:
- Understanding the interplay between interventions and context is crucial for designing effective maternity safety improvement strategies.
- This study provides a theoretically and empirically grounded analysis of factors contributing to safe maternity care.
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