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Understanding safety in maternity units through collaboration

Our framework describing 7 key features of safety in maternity units was developed through a 3 year multi-site ethnography & large stakeholder consultation.

Three years of research, over 400 hours of observations, 65 stakeholder interviews and one focus group led to the publication of the For Us (For Unit Safety) framework, an evidence-based framework describing seven key features of safety in hospital-based maternity care, in BMJ Quality and Safety.

Learning about healthcare safety often focuses on understanding what has gone wrong, but it is just as important to examine what good looks for safety in maternity units. Over the three years, I worked with a fantastic team and several collaborators. To ensure our study was as rigorous as possible, we combined several different methods and worked in a highly collaborative way across the system.

“With so much national focus on maternity safety and a personal passion for improving maternity care, it was a privilege to be interviewed as part of this important research. The 7 features of safety identified resonate strongly with my experience and I hope this framework will now be widely adopted as a model for maternity safety improvement nationally.”

James Titcombe OBE, Ambassador, Baby Lifeline

We started by working with clinicians in six UK-based maternity units. Since our project took place long before COVID-19 hit, we attended the units in person and used an ethnographic approach. I’ve written about ethnography previously: in a nutshell, it is about spending time in the context where people work or live, closely observing what is going on and talking to people to understand why things happen the way they do. We spent about 400 hours in total in these units, and held over 30 interviews with maternity care staff. Those data were the building blocks of the first draft of the For Us framework.

Next, we wanted to make sure the framework made sense to the people who would be using it, so we ran a large consultation exercise with a range of maternity care stakeholders.

“The team at THIS institute has made real efforts to take on the views from a wide range of stakeholders at various stage of the framework development. This included being part of the SCALING authorship group, making contributors like me feel valued and active participants”

Lia Brigante, Quality Standards Advisor at The Royal College of Midwives

We involved women who had recently used maternity services and could share their lived experience. And we talked to people with specialist knowledge, including midwives and obstetricians, improvement experts, commissioners, and policy makers. We made sure we included individuals at all levels of the hierarchy to cover a broad range of experiences. Different groups had quite different perspectives and contributed in different ways, but they all added huge value to the study. It was a fantastic experience to see the For Us framework evolving to become clearer and more user-friendly, and we were so grateful for people’s generosity and willingness to work with us.

Our work on maternity safety at THIS Institute is ongoing, and we will be thinking about how the For Us framework can inform future work. The framework is an illustration of the many elements that need to be in place to achieve safety, and how social science can help us better articulate them.

“Most satisfying is the contribution this work will make to building the evidence base behind the features essential to improving the safety of maternity and neonatal services and ultimately, enabling the realisation of our most important policy objective for maternity care.”

Michele Upton, Head of Maternity and Neonatal Safety, NHS England and NHS Improvement

Doing this research meant so much more to me than the academic papers can convey. It’s been quite an emotional experience at times, and I feel enormously privileged to have been allowed into maternity units, where the lives of so many families change forever.



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