SCALING
Research type
Research Study
Full title
Learning how to replicate and scale a successful maternity safety improvement programme
IRAS ID
219592
Contact name
Mary Dixon-Woods
Contact email
Sponsor organisation
Cambridge University Hospitals NHS Foundation Trust and The University of Cambridge
Duration of Study in the UK
2 years, 1 months, 30 days
Research summary
Initially promising healthcare improvement interventions often prove difficult to replicate and scale: what works in one setting may not be as effective, and may even be harmful, when implemented elsewhere. Excessive attention to quality improvement interventions in a narrow sense (e.g. checklists) risks overlooking enabling infrastructures that may be needed to secure authentic improvement. These technological, environmental, social, and cultural conditions are often relegated to the category of “context,” but are vital to the success of improvement efforts. It is therefore crucial to develop a conceptual and empirical understanding of the interactions between contexts and interventions.
This study aims to develop a model for the successful replication and scaling of improvement interventions, using the Southmead Maternity Unit (Bristol, UK) as a case study. Developing and adopting an evidence-based multi-professional training (PROMPT: PRactical Obstetric Multi-Professional Training), the Southmead Maternity Unit has reported sustained improvements in perinatal outcomes, as well as improved knowledge, clinical skills, and teamwork. However, propagating these successes beyond the context of origin has not been straightforward; some units have shown substantial improvement, while others have demonstrated more limited progress.
Using ethnographic observations and semi-structured interviews, we will produce a comprehensive account of the mechanisms underlying the safety outcomes observed in Southmead, including features both of its context and of specific interventions such as the PROMPT training. We will then use similar methods to evaluate the extent to which these mechanisms are present in a sample of UK maternity units that have attempted to implement PROMPT with different levels of success. Finally, we will develop an enhanced training package that incorporates, but is not limited to, the PROMPT intervention, to be known provisionally as LM-SIP (Learning-based Maternity Safety Improvement Programme). This will be tested and refined in four UK maternity units to be ready for deployment in a controlled trial.REC name
London - Harrow Research Ethics Committee
REC reference
17/LO/0740
Date of REC Opinion
28 Apr 2017
REC opinion
Favourable Opinion