Replicating and scaling a successful maternity safety improvement programme


There are no magic bullets in healthcare improvement, and efforts to improve quality and safety that are successful in one setting may not have the same success in another.

The safety improvements achieved by Southmead Hospital’s maternity unit help illustrate the importance of context. Since 2001, the Bristol-based unit has reduced its rate of clinical errors and made other sustained improvements to patient safety after developing and implementing a training programme. But when other organisations tried to implement the same programme, the results were mixed: sometimes big improvements, sometimes not.

Case studies like these show that interventions alone do not explain the outcomes. The technical, environmental, social and cultural conditions that foster high quality, safe care need to be better understood for improvement interventions to make authentic, positive and sustainable changes.


Our aim is to identify the role of, and interactions between, contextual features and specific interventions in contributing to the performance of an exceptionally safe maternity unit, and to use that knowledge to inform scalable improvements to maternity safety.

Our team of social scientists and clinicians will start by studying Southmead Hospital’s maternity unit to understand what made its improvement efforts so successful. Using an ethnographic approach, we will interview staff and observe them as they perform their daily work to identify the mechanisms that appear to be important for safety. We will then observe and interview staff at five other UK maternity units that also implemented PROMPT to enhance and deepen understanding of the mechanisms.

With this evidence, we will develop a prototype intervention aimed at helping maternity units and other acute care settings to replicate the conditions that enable improvement, and will explore acceptability, feasibility and relevance of the intervention using a literature review and stakeholder consultations.

This project is funded by the Health Foundation. It is expected to run until spring 2019, and its findings will feed into other THIS Institute studies. Check back for updates and research findings.