Title of ArticleAssessing contextual readiness: the first step towards maternity transformation
Type of ArticleOriginal Practice Development and Research
Author/sCiaran Crowe and Kim Manley
ReferenceVolume 9, Issue 2, Article 6
Date of PublicationNovember 2019
KeywordsAssessing contextual readiness, learning, maternity, PARiHS framework, person-centred care, quality, safety

Background: Health policy endorses best practice in maternity services as the quality triad of person-centred, safe and effective care. However, repeated inquiries into the quality of maternity services continue to identify concerns about culture, leadership and teamwork. Therefore support is needed to implement best practice. The Promoting Action on Research Implementation in Health Services framework (PARiHS) has the potential to inform the implementation of quality through an initial exploration of contextual readiness.

Aims and objectives: This paper describes the first phase of a quality transformation programme in a maternity service in England. It aims to assess the service’s context, using the PARiHS framework to identify enabling factors to guide the implementation of best practice.

Methods: Collaborative and participative analysis, underpinned by practice development methodology, used reflective insights from diary entries and meeting notes, combined with analysis of national data, local metrics and a staff culture survey. Inductive themes generated were mapped to the ‘context’ elements of PARiHS  to assess contextual readiness.

Results: Four themes emerged: language, leadership, learning and variability. Context mapping, showed low levels of leadership and culture and a medium level for evaluation. ‘Learning’ underpinned each contextual element and was described as: 1) a shared value needed for high-functioning learning cultures; 2) an attribute of collective leadership; and 3) key to evaluating what matters to women using the service and staff.

Conclusion: The PARiHS framework can help maternity services consider their contextual readiness to implement best practice. Assessing readiness is essential to prepare for successful transformation. Learning is the cornerstone of person-centred, safe and effective maternity care.

Implications for practice:

  • Using the PARiHS framework helps maternity services consider their contextual readiness to implement best practice
  • Leadership development and quality improvement knowledge are essential in helping maternity services to implement the quality triad of person-centred, safe and effective care
  • Collective learning in organisations influences teamwork, leadership and evaluation to reduce the occurrence of safety-related incidents
  • Maternity providers should be encouraged to see women as assets for collaborative learning

This article by Ciaran Crowe and Kim Manley is licensed under a Creative Commons Attribution Non-Commercial 3.0 License.

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