title: Confronting safety gaps across labor and delivery teams.
abstract: We assessed the occurrence of 4 safety concerns among labor and delivery teams: dangerous shortcuts, missing competencies, disrespect, and performance problems. A total of 3282 participants completed surveys, and 92% of physicians (906 of 985), 93% of midwives (385 of 414), and 98% of nurses (1846 of 1884) observed at least 1 concern within the preceding year. A majority of respondents said these concerns undermined patient safety, harmed patients, or led them to seriously consider transferring or leaving their positions. Only 9% of physicians, 13% of midwives, and 13% of nurses shared their full concerns with the person involved. Organizational silence is evident within labor-and-delivery teams. Improvement will require multiple strategies, used at the personal, social, and structural levels.
authors.affiliation: Department of Research, VitalSmarts LC, Provo, UT. Electronic address: dmaxfield@vitalsmarts.com.
authors.forename: David G
authors.initials: DG
authors.lastname: Maxfield
authors.forename: Audrey
authors.initials: A
authors.lastname: Lyndon
authors.forename: Holly Powell
authors.initials: HP
authors.lastname: Kennedy
authors.forename: Daniel F
authors.initials: DF
authors.lastname: O'Keeffe
authors.forename: Marya G
authors.initials: MG
authors.lastname: Zlatnik
mesh_terms: D001291:Attitude of Health Personnel; D003142:Communication; D036861:Delivery, Obstetric / Q000451:nursing / Q000592:standards; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D019300:Medical Errors / Q000517:prevention & control*; D008880:Midwifery / Q000592:standards; D009773:Obstetric Nursing / Q000592:standards; D009774:Obstetrics / Q000458:organization & administration / Q000592:standards*; D015279:Organizational Culture; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards*; D061214:Patient Safety / Q000592:standards; D011247:Pregnancy; D011795:Surveys and Questionnaires
keywords: communication; organizational silence; patient safety; psychological safety