Seven features of safety in maternity units: a framework based on multisite ethnography and stakeholder consultation
Creators: name: Liberati, Elisa Giulia
name: Tarrant, Carolyn
name: Willars, Janet
name: Draycott, Tim
name: Winter, Cathy
name: Kuberska, Karolina
name: Paton, Alexis
name: Marjanovic, Sonja
name: Leach, Brandi
name: Lichten, Catherine
name: Hocking, Lucy
name: Ball, Sarah
name: Dixon-Woods, Mary
name: Group, The SCALING Authorship
name: Bevens, Cathy
name: Brigante, Lia
name: Brintworth, Kate
name: Burt, Jenni
name: Carlile, Carol
name: Chaffer, Denise
name: Chakrabarti, Sanhita
name: Christmas, Tracey
name: Clark-Ward, Victoria
name: Clements, Sophie
name: Crofts, Joanna
name: Davis, Paul
name: Deacon, Lesley
name: Donald, Fiona
name: Duckett, Rachel
name: Duffy, James M.N.
name: Dyson, Charlotte
name: Edwards, Sian
name: Farrar, Diane
name: Fogarty, Matthew
name: Forrester, Mandy
name: Fowler, Aidan
name: Haddon, Richard
name: Halliday, Robyn
name: Harmer, Clea
name: Houghton, Jill
name: Johnston, Carolyn
name: Jolly, Matthew
name: Kaur-Desai, Tejinder
name: Kelly, Tony
name: Kirby, Joy
name: Leslie, Karin
name: Lewis, Sandy
name: Lindley, Amanda
name: Locock, Louise
name: Lucas, Nuala
name: Lyndon, Audrey
name: Mackintosh, Nicola
name: Matthews, Joanne
name: McCulloch, Bernadette
name: McHugh, Siobhan
name: Merritt, Sarah
name: Morris, Edward
name: Nicol, Alison
name: Patil, Anita
name: Percival, Rebecca
name: Pradhan, Farrah
name: Punch, Daniel
name: Rowley, Amanda
name: Roy, Catherine
name: Russell, Elizabeth
name: Rzewuska, Magdalena
name: Simpson, Kathleen
name: Titcombe, James
name: Upton, Michele
name: Walton, Gill
name: Wells-Munro, Sascha
name: Wilson, Caitlin
name: Wilson-Crellin, Rebecca
name: Wright, Alison
name: Yau, Christopher
Publisher: name: Apollo - University of Cambridge Repository
Year: 2020
Subjects: Original research
1506
qualitative research
healthcare quality improvement
patient safety
obstetrics and gynecology

description: 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.