Barriers to implementing the WHO Safe Childbirth Checklist in maternity hospitals, Brazil

Area of Science:

• Healthcare Management
• Patient Safety
• Implementation Science

Background:

• The World Health Organization Safe Childbirth Checklist (SCC) aims to improve maternal and newborn outcomes.
• Successful SCC implementation is crucial but faces context-specific challenges.

Purpose of the Study:

• To identify barriers to SCC implementation in high-risk and routine-risk maternity hospitals.
• To develop a causal model for SCC implementation barriers.

Main Methods:

• Qualitative, exploratory study using focus groups and brainstorming sessions.
• Data collected from healthcare professionals and patient safety members in two public maternity hospitals.
• Content analysis based on the Consolidated Framework for Implementation Research (CFIR) and causal model development using a fishbone diagram.

Main Results:

• Barriers identified across CFIR domains: Innovation (checklist design/complexity), Inner Setting (safety culture, infrastructure), and Implementation Process (planning, stakeholder involvement, feedback).
• Routine-risk facilities additionally faced Outer Setting barriers related to continuing education policies.
• High-risk facilities did not report the Outer Setting barrier.

Conclusions:

• SCC implementation is hindered by structural, cultural, and adaptation challenges.
• Inadequate investment in training, high staff turnover, and lack of specific protocols impede consistent SCC use.
• Comprehensive strategies are needed to improve SCC adherence and integration in maternal-newborn care.