Health-care professionals' views about safety in maternity services: a qualitative study.
OBJECTIVE
to explore health-care professionals' views about safety in maternity services. This paper identifies aspects of care that are less safe than they should be, possible ways to improve safety, and potential obstacles to achieving these improvements. This study was part of the King's Fund inquiry into the safety of maternity services in England.


METHODS
qualitative study with a sample of health-care professionals who work in maternity services and who responded to the call for evidence. Data were collected by questionnaire and analysed using thematic content analysis.


METHODS
maternity professionals throughout England were invited to take part.


METHODS
midwives, obstetricians, student midwives, nurses, neonatal nurses, general practitioners, managers, hospital doctors and paediatricians. In total, there were 591 respondents.


RESULTS
participants were asked to respond to open-ended questions identifying aspects of maternity care that were less safe than they should be, potential solutions to improve safety of care, and any barriers to implementing these improvements. Problems described included the increasing social and medical complexity of the pregnant population, low staffing levels, inappropriate skill mix, low staff morale, inadequate training and education, medicalisation of birth, poor management, lack of resources and reconfiguration. Proposed solutions included more staff, better teamwork and skill mix, improved training, more one-to-one care, caseloading, better management, more resources, better guidelines and learning from incidents. Barriers to implementing improvements included stressed staff who were resistant to change, inadequate management/poor staff management relationships and financial restraints.


CONCLUSIONS
the responses of maternity professionals convey a deep sense of staff anxiety regarding how the problems they face pose a threat to safety.


CONCLUSIONS
policy makers and professional bodies need to take the concerns expressed by staff seriously. Concerted efforts are required to improve maternity services and support maternity professionals.
Smith
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King's Fund, 11-13 Cavendish Square, London W1G 0AN, UK. a.smith@kingsfund.org.uk
Dixon
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D000739:Anecdotes as Topic; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D004739:England / Q000453:epidemiology; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008427:Maternal Health Services / Q000458:organization & administration*; D008429:Maternal Welfare / Q000706:statistics & numerical data; D011369:Professional-Patient Relations; D011785:Quality Assurance, Health Care; D017751:Safety Management / Q000706:statistics & numerical data*