title: Using data and quality monitoring to enhance maternity outcomes: a qualitative study of risk managers' perspectives.
abstract: BACKGROUND
  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.
authors: Department of Women's Health, North Bristol NHS Trust, Bristol, UK School of Clinical Sciences, University of Bristol, Bristol, UK.
authors: Rebecca A
authors: RA
authors: Simms
authors: Faculty of Health and Life Sciences, University of the West of England, Bristol, UK.
authors: Andrew
authors: A
authors: Yelland
authors: Department of Women's Health, North Bristol NHS Trust, Bristol, UK.
authors: Helen
authors: H
authors: Ping
authors: Faculty of Health and Life Sciences, University of the West of England, Bristol, UK.
authors: Antonia J
authors: AJ
authors: Beringer
authors: 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.
authors: Timothy J
authors: TJ
authors: Draycott
authors: Department of Women's Health, Taunton & Somerset NHS Foundation Trust, Taunton, UK.
authors: Robert
authors: R
authors: Fox
mesh_terms: D019985:Benchmarking; D004739:England; D005260:Female; D006801:Humans; D007351:Insurance, Liability; D007407:Interviews as Topic; D008880:Midwifery / Q000379:methods / Q000458:organization & administration; D009775:Obstetrics and Gynecology Department, Hospital / Q000458:organization & administration* / Q000592:standards; D015279:Organizational Culture; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D036301:Qualitative Research; D058996:Quality Improvement / Q000458:organization & administration; D011787:Quality of Health Care / Q000458:organization & administration; D012308:Risk Management / Q000379:methods* / Q000458:organization & administration
keywords: Healthcare quality improvement; Patient safety; Performance measures; Risk management; Safety culture