Quality of Maternity Care – An Organisational Ethnography
Research type
Research Study
Full title
Organisational features associated with women’s experiences of good quality care in maternity units in the UK and Belgium: A multicountry organisational ethnography
IRAS ID
287040
Contact name
Soo Downe
Contact email
Sponsor organisation
University of Central Lancashire
Clinicaltrials.gov Identifier
n/a, n/a
Duration of Study in the UK
1 years, 0 months, 1 days
Research summary
Research Summary
Background:
Inequalities in access to women’s healthcare and significant variations in the provision, practice and outcomes of maternity care exist. The implementation of evidence based care could improve public health as long as this also respects woman’s human rights, and their desire for a positive experience. Ideally, the design on which any maternity service is built should be based on local women’s needs and wishes.
Given the importance of women’s views and experiences, the study will build on the Babies Born Better (B3) survey, an international, anonymous, mixed methods online instrument capturing the views of women in regards to their experience of maternity care which can be linked to the unit where they gave birth.Research question:
Based on sites identified through women’s responses to the B3 survey, which cultural, organisational and clinical elements can be observed in high performing maternity sites in the United Kingdom and Belgium.Aim:
This PhD study aims to identify contrasting maternity sites based on the B3 survey, outcome indicators and the current evidence around the meaning of ‘high quality’ in maternity care, and to explore which organisational approaches and practices are associated with good outcomes and positive experiences for mothers and babies.Methods:
The current evidence base on the meaning of ‘high quality’ for a maternity unit will be explored from multiple perspectives by conducting a meta-narrative review (Phase 1). Next, a new algorithm to categorise maternity sites based on the findings of the review, and outcomes of the B3 Survey in combination with other outcome indicators such as adverse outcomes, intervention rates, staff and women’s experiences will be created (Phase 2). An organisational ethnography will then be undertaken in four contrasting units by conducting a documentary analysis, observations, interviews and focus-groups with stakeholders (Phase 3).Potential Impact:
The findings could be used as a resource for the improvement of maternal and childbirth care in the world.Summary of Results
Chief Investigator: Prof. Soo Downe
PhD student: Ellen Thaels
Supervisory team: Prof. Soo Downe, Dr Gordon Prescott, Marie-Clare Balaam
Sponsor: University of Central Lancashire Study start- and end date: 06/09/2021 – 01/06/2023Background:
A consensus exists between different constituencies involved at all levels of maternity care that high quality care is important. The implicit assumption is that everyone defines and understands the idea of quality in maternity care identically. However, contemporary debate about where the balance between safety and personalisation in maternity care lies, raises important questions about the different definitions that might be operating when people talk about ‘Quality’ in this context.Methods:
An in-depth organisational ethnography in two diverse maternity units within one English NHS Trust was conducted to answer the following research question:
“How is quality of care conceptualised by the different constituencies involved in maternity care in the UK? An organisational ethnography”
Public involvement included the consultation of a service user group associated with the trust in which data collection took place. During a Maternity Voices partnership meeting (an NHS working group consisting of women and their families, commissioners, and frontline staff) seeking to contribute to the development of local maternity care, I presented the research project and asked for feedback around the design and aims of the study. I received valuable and novel insights into specific factors to consider in the study (e.g., who I should talk to, what kind of questions are important to ask etc.). The group mainly emphasised the importance of including women and their partners and asking them about their expectations of- and perceived quality of maternity care.
Methods for data-collection included interviews, focus-groups, documentary analysis and observations. Framework analysis, based on the six dimensions of quality from the Institute of Medicine, was applied inductively to analyse the data.Findings:
Forty-eight participants (managers, frontline staff, women, and their birthing partners) were recruited for the organisational ethnography. Twenty-seven interviews and two focus-groups were conducted. One hundred and eighty hours of observation took place, and fifteen documents were collected.
Results indicate that, the understanding and implementation of ‘quality of maternity care’ was not uniform. Closely interlinked factors such as safety and personalisation were seen as separate entities, where the organisation’s definition of safety was largely prioritised over the woman’s personal or individual preferences.Conclusions:
Even though people think they are communicating a shared concept when they talk about quality of maternity care, this study suggests that their underlying definitions for the term may differ substantially. High quality maternity care goes far beyond preventing morbidity and mortality. The implementation of a clear and shared vision about what goes well, for whom, under what circumstances is necessary for a maternity service to thrive.Thank you:
The research team would like to extend their gratitude to all participants involved in this research project. The insights provided on personal views about quality of maternity care were invaluable.REC name
South East Scotland REC 02
REC reference
21/SS/0018
Date of REC Opinion
3 Mar 2021
REC opinion
Further Information Favourable Opinion