This research looks at what good safety culture looks like in maternity services and the features underpinning it.
We commissioned the Healthcare Improvement Studies Institute (THIS Institute) and RAND Europe to carry out this evaluation. They wrote the summary below, and the full report.
Why it matters
Several reviews and inquiries in recent years which have raised concerns about the safety of maternity care in England. In 2022, the Care Quality Commission (CQC) – the regulator for health and social care – began a new maternity inspection programme. It aimed to review all maternity services in England that had not been inspected or rated since April 2021.
In 2023, CQC commissioned The Healthcare Improvement Studies Institute (THIS Institute) and RAND Europe to evaluate the maternity inspection programme. The evaluation had two objectives:
- Identify and describe what good safety culture looks like in maternity and the features underpinning it;
- Look at the maternity inspection programme to learn about how it had been delivered and learn from it to inform the work of maternity services, inspectors, and the health and care system more broadly.
This report describes the work we did to address the first of these objectives.
While much attention is given to what goes wrong in maternity care, a lot of value can be gained by understanding what good looks like. This evaluation produced practical advice on how to improve the inspection programme, and developed a ‘learning resource’ describing the key features of ‘what good looks like’ in safe, high-quality maternity care.
Our approach
We used a range of different research methods in our work to describe what a good safety culture looks like in maternity services, including:
- reviews of existing publications to help determine what good looks like in maternity safety from the perspectives of maternity service users, staff, inspectors, and other stakeholders;
- workshops with 15 maternity service users;
- an online survey to hear from over 200 people on what good safety culture looks like in maternity care;
- a review of our existing ‘For Us’ framework, which first described what good looks like for safe, high-quality maternity care, to develop it with up-to-date insights from the research literature, workshop participants and survey respondents.
What we found
Some of the features presented in the original ‘For Us’ framework stayed much the same, but some have been changed substantially because of this evaluation. The biggest change is an increased focus on the need for services to work hard to ensure that maternity service users from diverse backgrounds feel understood, heard and included. Linked to this is an emphasis on the active steps needed to ensure that staff, women, and birth partners are treated with respect and listened to regardless of their background. The learning resource strongly emphasises the importance of eliminating racism and any form of discrimination based on ethnic and cultural background both between colleagues and between staff and maternity service users.
The learning resource outlines eight features:
- Commitment to safety and improvement at all levels, with everyone involved;
- Technical competence that is attentive to diverse health needs and supported by formal training and informal learning;
- Optimised teamwork, team communication and coordination;
- Constant reinforcing of inclusive, respectful, and ethical behaviours towards all colleagues and all maternity service users;
- Clear, respectful communication that is culturally competent and accounts for diversity, and permits informed decision-making by maternity service users;
- Multiple approaches in place to detect problems, used as a basis for action, and supported by active nurturing of the conditions for psychological safety;
- Structures, systems, and processes designed for safety and regularly reviewed and optimised, guided by human factors/ergonomics principles where appropriate;
- High-quality leadership and management.
The learning resource helps to identify and describe these features of high-quality care. It offers an important step towards building a shared understanding of ‘what good looks like’ in safe, high-quality maternity care.