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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 flounder in another. The technical, environmental, social and cultural conditions that foster high quality, safe care need to be better understood if improvement interventions are to make authentic, positive and sustainable changes.


We aimed 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 started by studying the Southmead Hospital’s maternity unit to understand what made its improvement efforts so successful. 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 safety improvement programme called PROMPT. Using an ethnographic approach, we interviewed staff and conducted observations as they performed their daily work to identify the mechanisms that appeared to be important for safety. To enhance and deepen understanding of the features of safety, we then conducted observations and interviews with staff at five further UK maternity units that had also implemented the PROMPT programme.

A large-scale stakeholder consultation followed. It involved women who had recently used maternity services, frontline clinicians, improvement experts, policy makers, and other key stakeholders.

The result was a plain-language framework named For Us (For Unit Safety). Describing seven features of safety in maternity units in a clear and accessible way, it aims to promote understanding, reflection, and shared learning on ‘what good looks like’ for providing safe maternity care.

This project was funded by the Health Foundation. The work finished in April 2019, and you can read about the findings by clicking on the links to related publications below. The findings from this work continue to inform other THIS Institute studies aimed at improving maternity care.

Funding and ethics

This study is funded by the Health Foundation’s grant to THIS Institute. It is led independently by THIS Institute. The study was reviewed by the London – Harrow Research Ethics Committee

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