King's College London

Maternity care services should provide care that is both safe and respectful of service user choices and decisions. Safe, high-quality maternity care means that mothers and babies leave the service fit and well and that they have good experiences, with skilled, kind staff who can provide what is needed, when it is needed. However, in England, there have been serious failings in several maternity units showing that safe, high-quality maternity care has not always been provided. Several recent public inquiries have come up with recommendations for improvements, based on what went wrong. However, designing change only based on what goes wrong may miss what goes right. Even more, such changes may damage what was going well. We want to try a new approach, including lessons from what goes right and what goes wrong (known as ‘Safety II’), to improve maternity care in the future.

This project aims to complete the initial work required to find out whether we can identify high-performing maternity units and understand how and why they work well. To do this, we will work with a wide range of people, including extensive public and patient involvement and engagement, to find out what matters to them in terms of women and staff experience; childbirth outcomes; and good use of resources. We also want to find out what they think drives these positive factors (‘what works and how?’), and how we can best measure them. We will look at the existing evidence to see how far our ‘explanation of what works’ is reflected in what has been published so far. Then, all this information will be developed into an assessment tool which will be tested (later on) to see if it can help us identify ‘Beacon’ Sites to study further. All this work will help our longer-term aim of finding out whether we can apply the lessons of high-performing maternity units to others, to stimulate national improvements.

Developmental work plan

1. To set up a public and service user stakeholder engagement strategy including outreach to underrepresented

groups to collectively decide what key outcome measures are most important. These measures will relate to health outcomes, women’s wellbeing, staff wellbeing, and resource use.

1. To identify and collate the available evidence to understand what works and why in maternity units.
2. To develop and refine an explanation of what works and why.
3. Using these findings, to develop an assessment tool which can identify high-performing maternity units.
4. To design another research study that makes use of the information gathered.
5. To apply for further grant funding to carry out the next stage of research in step 5.
6. To share the findings from this initial work.

This study/project is funded by the National Institute for Health and Care Research (NIHR) [Programme Development Grant- NIHR206404]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.”

Partners

Professor Andrew Booth is a partner of the project. 

Professor Booth has been with the School of Health and Related Research (ScHARR) at the University of Sheffield since 1994 and is a Professor in Evidence Synthesis. With over 35 years of experience in health information, he has managed the Information Resources Section and taught on various Masters programs in Public Health and Health Informatics. A systematic review methodologist, he co-convenes the Cochrane Collaboration Qualitative & Implementation Research Methods Group and is a member of several other Cochrane groups. He also serves as the Director of Information (Research Outputs) at ScHARR. In recognition of his contributions to health librarianship, he was awarded the Cyril Barnard Memorial Prize by the CILIP Health Libraries Group in 2011.