title: Perinatal staff perceptions of safety and quality in their service.
abstract: BACKGROUND
  Ensuring safe and appropriate service delivery is central to a high quality maternity service. With this in mind, over recent years much attention has been given to the development of evidence-based clinical guidelines, staff education and risk reporting systems. Less attention has been given to assessing staff perceptions of a service's safety and quality and what factors may influence that. In this study we set out to assess staff perceptions of safety and quality of a maternity service and to explore potential influences on service safety.
  
  
  METHODS
  The study was undertaken within a new low risk metropolitan maternity service in Victoria, Australia with a staffing profile comprising midwives (including students), neonatal nurses, specialist obstetricians, junior medical staff and clerical staff. In depth open-ended interviews using a semi-structured questionnaire were conducted with 23 staff involved in the delivery of perinatal care, including doctors, midwives, nurses, nursing and midwifery students, and clerical staff. Data were analyzed using naturalistic interpretive inquiry to identify emergent themes.
  
  
  RESULTS
  Staff unanimously reported that there were robust systems and processes in place to maintain safety and quality. Three major themes were apparent: (1) clinical governance, (2) dominance of midwives, (3) inter-professional relationships. Overall, there was a strong sense that, at least in this midwifery-led service, midwives had the greatest opportunity to be an influence, both positively and negatively, on the safe delivery of perinatal care. The importance of understanding team dynamics, particularly mutual respect, trust and staff cohesion, were identified as key issues for potential future service improvement.
  
  
  CONCLUSIONS
  Senior staff, particularly midwives and neonatal nurses, play central roles in shaping team behaviors and attitudes that may affect the safety and quality of service delivery. We suggest that strategies targeting senior staff to enhance their performance in their roles, particularly in the training and teamwork role-modeling of the transitory junior workforce, are important for the development and maintenance of a high quality and safe maternity service.
authors.affiliation: The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University and MIMR-PHI Institute of Medical Research, 246 Clayton Road, Clayton, Victoria, 3168, Australia. suzanne.sinni@monash.edu.
authors.forename: Suzanne V
authors.initials: SV
authors.lastname: Sinni
authors.affiliation: The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University and MIMR-PHI Institute of Medical Research, 246 Clayton Road, Clayton, Victoria, 3168, Australia. euan.wallace@monash.edu.
authors.forename: Euan M
authors.initials: EM
authors.lastname: Wallace
authors.affiliation: School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia. wendy.cross@monash.edu.
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Cross
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D055318:Evidence-Based Nursing / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D016389:Maternal-Child Nursing / Q000592:standards*; D008875:Middle Aged; D008880:Midwifery / Q000592:standards*; D009732:Nursing Care / Q000592:standards*; D009740:Nursing Staff / Q000523:psychology*; D061214:Patient Safety / Q000592:standards*; D010820:Physicians / Q000523:psychology*; D011247:Pregnancy; D011787:Quality of Health Care / Q000592:standards; D014739:Victoria