Title of ArticlePerson-centred, safe and effective care in maternity services: the need for greater change towards best practice
Type of ArticleCritical Review of Literature
Author/sCiaran Crowe and Kim Manley
ReferenceVolume 9, Issue 1, Article 8
Date of PublicationMay 2019
KeywordsBest practice, PARiHS framework, inquiries, context, maternity services, effective care, safe care, person-centred


Background: Safer maternity care, defined as a triad of safe, effective and person-centred care, is a global health priority. Having a baby in the UK has never been safer, yet several inquiries in England over the past decade have made wide-ranging recommendations to improve the safety of maternity services. These recommendations relate to local and national maternity services, as well as to the wider healthcare system. This pattern of findings and recommendations has been reflected in maternity service reviews internationally. A review of maternity services in England found considerable variation in their quality, identifying that more needs to be done to make services safer, more personalised, kinder, professional and more family friendly. Regulators continue to raise safety concerns for the majority of maternity units in England, concerns that are echoed internationally.

Aims and objectives: The purpose of this article is to identify learning from relevant inquiries into the quality, safety and variation of maternity services, in order to develop understanding about what best practice looks like in maternity settings, and the relevant contextual factors important when implementing best practice in an NHS maternity service. These insights were intended to inform the implementation of best practice in a single site maternity unit in England, described elsewhere.

Methods: Five inquiries with relevance to maternity practice since 2013 (one local with national recommendations, two national and two international), two subsequent national reviews and a further 17 key service publications over 10 years from the grey literature have been identified as sources of data for analysis of best practice.

Findings/results: Three key themes were distilled: framing best practice in relation to the quality triad of patient experience, safety and clinical effectiveness; the need to implement the lessons learned from inquiries into quality and safety; and the importance of contextual factors including leadership, learning and teamwork as enablers of best practice.

Conclusions: Implementing best practice and learning from quality of care inquiries are identified as key challenges when providing person-centred, safe and effective care mediated through contextual factors such as learning, leadership and teamwork. Implementation may be assisted by using the Promoting Action on Research Implementation in Health Services (PARiHS) framework as an analytical framework to assess the context of maternity settings, because of its strengths in contextual analysis for implementation. In combination with practice development methodology, this is a potential approach for facilitating collaborative action towards best practice at the implementation stage.
Implications for practice:

  • Maternity units need help to support their teams in implementing best practice and lessons emerging from public inquiries
  • The achievement of best practice, described as person-centred, safe and effective, is interdependent with factors such as leadership, culture and teamwork
  • The use of the PARiHS framework may be useful to explore the context of a maternity unit when implementing best practice
  • An assessment of the readiness of maternity units to embrace best practice should include an examination of context, defined as a focus on culture, leadership and evaluation
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