THINK.CHANGE.DO

1
Understanding the safety culture in Australian
maternity services
THINK.CHANGE.DO
Suellen Allen
Centre for Midwifery, Child and Family Health
University of Technology Sydney Australia PhD
Candidate
2
Overview of presentation
Background

• Discuss a study examining safety culture in two
  maternity services in Sydney, Australia
• Outline of the problem
• Results
• Lessons

3
The problem adverse events in maternity care

Background

• In New South Wales in 2006
• 2000 events reported
• 36 were serious events
• 8 of all serious events reported in NSW
• Types of incidents
• Transfer of care
• Antenatal assessment
• Escalation of risk factors during labour and
  birth
• Fetal welfare assessment

4
Maternity adverse events
Background

• Causes
• Multiple factors
• Communication problems
• Complexity and fragmentation
• Understanding safety culture may be a strategy to
  improve safety

5
What is safety culture?

• The complex framework of national, organisational
  and professional attitudes and values within
  which groups and individuals function that
  influence the safety of an organisation.
• Includes a number of factors known as safety
  domains
• Teamwork
• Safety climate
• Job satisfaction
• Perception of management
• Stress recognition
• Working conditions
• (Helmreich Merrit, 2001
  Sexton, et al, 2003)

6
Study aim
Background

• To identify whether measuring the safety
  culture within a maternity service is a useful
  process to develop strategies to improve the
  safety culture in maternity care

7
Study context

• PhD study researcher was an outsider to
  organisation
• Setting
• Two metropolitan hospital maternity units in
• Sydney, Australia in 2006-2007
• Policy Context
• Patient Safety and Clinical Quality Program
• Incident reporting and management
• Clinical governance structures
• Concurrent external factors
• Health service restructure/amalgamation
• Reorganisation of leadership and support roles

8
Planned study

9
Results of Safety Attitudes Questionnaire - Stage
one
Overall mean (SAFETY CULTURE)
Working conditions
Job satisfaction
Perception of management
Stress recognition
Teamwork
Safety Climate
10
Suggested areas for improvement
11
Strategy for change

• Result feedback to participants
• Local stakeholders lacked capacity to
  participate in strategy
• development and implementation
• Measurement of improvement
• Study was suspended
• Improvement strategies were not undertaken
• Analysis of barriers to developing positive
  safety cultures

12
Barriers identified

• External factors influencing safety culture
• Challenges of organisation restructure
• Transition period created instability
• Restructure implemented concurrently with
  Patient Safety
• and Clinical Quality Program
• Complexity and competing demands of implementing
  both
• policies and continuing to provide clinical
  services

13
Lessons learnt

• Safety culture measurement identified areas to
  improve safety
• Development and implementation of safety
  improvement
• strategies was limited by
• Local stakeholder capacity to engage
• Mandate to make changes
• Researcher as an outsider
• Lack of engagement of stakeholders at executive
  level
• Competing external factors
• Competing demands on resources at study sites
• Reduced capacity to improve safety culture

14
Message

• Safety culture is measurable and context
  specific
• Can be influenced by external factors which
  should be
• considered prior to developing safety
  improvement
• strategies
• Engagement and buy in at executive management
  and
• local clinical level is essential
• Measuring safety culture is useful if you have
  the
• capacity to follow through with improvement
• strategies

15
Thank you