Systems Safety: Identifying Facilitators, Barriers, and Failure Modes to Quality Patient Care on a Postnatal Unit

The postpartum period is critical for safeguarding the health and well-being of birthing parents. After delivery, birthing parents will spend an average of 24 to 48 hours in the hospital during the postnatal stay where health care workers (HCWs) monitor them, identify treatment needs, assist with breastfeeding, conduct depression assessments, and provide education. Identifying clinical system factors hindering the provision of high-quality care is critical to improving care and addressing the challenges faced by HCWs and birthing parents during inpatient postpartum care. Thus, this study was to identify barriers and facilitators that impact HCWs' work and care delivery within the postnatal unit.

The study involved a secondary analysis of observational data collected in a postnatal unit of a large, academic hospital in the United States. Barriers and facilitators were identified and coded using the System Engineering and Initiative for Patient Safety 2.0 model and the Healthcare Performance Improvement Taxonomies of Individual and System Failure Modes.

A total of 87 barriers and 18 facilitators were identified. Common barriers included challenges with communication between HCWs, insufficient and unclear patient education, space constraints, and insufficient tools and technology. Facilitators included informed consent with patients and accessible educational tools that support HCWs in the provision of care.

The findings from this research can inform the design and improvement of postnatal units to improve patient safety and support HCWs in providing high-quality, responsive, and patient-centered care.