Rebecca A Simms1, Andrew Yelland2, Helen Ping3, Antonia J Beringer2, Timothy J Draycott4, Robert Fox5. 1. Department of Women's Health, North Bristol NHS Trust, Bristol, UK School of Clinical Sciences, University of Bristol, Bristol, UK. 2. Faculty of Health and Life Sciences, University of the West of England, Bristol, UK. 3. Department of Women's Health, North Bristol NHS Trust, Bristol, UK. 4. Department of Women's Health, North Bristol NHS Trust, Bristol, UK School of Clinical Sciences, University of Bristol, Bristol, UK The Health Foundation, London, UK. 5. Department of Women's Health, Taunton & Somerset NHS Foundation Trust, Taunton, UK.
Abstract
INTRODUCTION: Risk management is a core part of healthcare practice, especially within maternity services, where litigation and societal costs are high. There has been little investigation into the experiences and opinions of those staff directly involved in risk management: lead obstetricians and specialist risk midwives, who are ideally placed to identify how current implementation of risk management strategies can be improved. METHODS: A qualitative study of consultant-led maternity units in an English region. Semistructured interviews were conducted with the obstetric and midwifery risk management leads for each unit. We explored their approach to risk management, particularly their opinions regarding quality monitoring and related barriers/issues. Interviews were recorded, transcribed and thematically analysed. RESULTS: Twenty-seven staff from 12/15 maternity units participated. Key issues identified included: concern for the accuracy and validity of their local data, potential difficulties related to data collation, the negative impact of external interference by national regulatory bodies on local clinical priorities, the influence of the local culture of the maternity unit on levels of engagement in the risk management process, and scepticism about the value of benchmarking of maternity units without adjustment for population characteristics. CONCLUSIONS: Local maternity risk managers may provide valuable, clinically relevant insights into current issues in clinical data monitoring. Improvements should focus on the accuracy and ease of data collation with a need for an agreed maternity indicators set, populated from validated databases, and not reliant on data collection systems that distract clinicians from patient activity and quality improvement. It is clear that working relationships between risk managers, their own clinical teams and external national bodies require improvement and alignment. Further discussion regarding benchmarking between maternity units is required prior to implementation. These findings are likely to be relevant to other clinical specialties. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
INTRODUCTION: Risk management is a core part of healthcare practice, especially within maternity services, where litigation and societal costs are high. There has been little investigation into the experiences and opinions of those staff directly involved in risk management: lead obstetricians and specialist risk midwives, who are ideally placed to identify how current implementation of risk management strategies can be improved. METHODS: A qualitative study of consultant-led maternity units in an English region. Semistructured interviews were conducted with the obstetric and midwifery risk management leads for each unit. We explored their approach to risk management, particularly their opinions regarding quality monitoring and related barriers/issues. Interviews were recorded, transcribed and thematically analysed. RESULTS: Twenty-seven staff from 12/15 maternity units participated. Key issues identified included: concern for the accuracy and validity of their local data, potential difficulties related to data collation, the negative impact of external interference by national regulatory bodies on local clinical priorities, the influence of the local culture of the maternity unit on levels of engagement in the risk management process, and scepticism about the value of benchmarking of maternity units without adjustment for population characteristics. CONCLUSIONS: Local maternity risk managers may provide valuable, clinically relevant insights into current issues in clinical data monitoring. Improvements should focus on the accuracy and ease of data collation with a need for an agreed maternity indicators set, populated from validated databases, and not reliant on data collection systems that distract clinicians from patient activity and quality improvement. It is clear that working relationships between risk managers, their own clinical teams and external national bodies require improvement and alignment. Further discussion regarding benchmarking between maternity units is required prior to implementation. These findings are likely to be relevant to other clinical specialties. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Authors: Malini Anand Nijagal; Stephanie Wissig; Caleb Stowell; Elizabeth Olson; Isis Amer-Wahlin; Gouke Bonsel; Allyson Brooks; Matthew Coleman; Shamala Devi Karalasingam; James M N Duffy; Tracy Flanagan; Stefan Gebhardt; Meridith E Greene; Floris Groenendaal; J Ravichandran R Jeganathan; Tessa Kowaliw; Marije Lamain-de-Ruiter; Elliott Main; Michelle Owens; Rod Petersen; Irwin Reiss; Carol Sakala; Anna Maria Speciale; Rachel Thompson; Oluwakemi Okunade; Arie Franx Journal: BMC Health Serv Res Date: 2018-12-11 Impact factor: 2.655
Authors: Sara Tolf; Johan Mesterton; Daniel Söderberg; Isis Amer-Wåhlin; Pamela Mazzocato Journal: BMC Health Serv Res Date: 2020-09-01 Impact factor: 2.655