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Seven features of safety in maternity units: A framework based on multi-site ethnography and stakeholder consultation

This paper explains how a new plain-language framework, the For Us (For Unit Safety) framework, was developed through a multi-site ethnographic study and stakeholder consultation. The framework identifies the behaviours and practices that appear to be features of safe care in hospital-based maternity units.

The study seeks to characterise features of safe care in maternity units. Hospital-based maternity units in the study displayed features that reinforce each other to optimise safety. The paper describes these features in a plain language framework, the For Us – For Unit Safety framework.

The framework doesn’t tell staff working in maternity units what to do. Instead it aims to aid reflection and collective learning and to target improvement efforts.

The seven features of safety are:

  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

The For Us framework is grounded in data and was built in a highly collaborative way, with over 400 hours of observations across six maternity units, a focus group, plus 65 stakeholder interviews with midwives, doctors, NHS managers, women who had recently used maternity services, policy makers, and members of royal colleges.

Preventable harm in maternity care has devastating consequences for families, and the associated negligence claims create huge costs for the NHS. Reducing harm in maternity care is a major priority to protect families and NHS sustainability. Much work to date has focused on identifying what goes wrong in maternity care. This study takes a fresh, positive perspective and shares learning about what good looks like for safety in maternity units. The result is the For Us framework, which identifies the behaviours and practices that appear to be features of safe care in hospital-based maternity units.

The For Us framework is an evidence-based framework that aims to support staff working in maternity units to reflect on what good looks like in a safe maternity unit, to identify and agree on priorities for improvement, celebrate achievements, or to make a case for increasing investment to achieve safety.

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