Harnessing ‘everyday moments’ for transformative change in local safety cultures in maternity and neonatal care settings

Safety culture refers to the attitudes, beliefs and values that shape how work is done, particularly in relation to managing risks and improving safety. Safety culture tends to be difficult to operationalise given its abstract nature, which can hamper local improvement
efforts. Our research into safety culture development in maternity and neonatal care confirmed the importance of values that are enacted through policies, operational routines, and shared collaborative practices for understanding local safety cultures. We developed a theory-based interpretive framework that has filled a critical gap in training resources available for healthcare teams to explore and enrich their own safety cultures. It has empowered policymakers, clinical and practice development leads (both within and beyond NIHR Infrastructure Impact Story Template 2023/24 maternity and neonatal care settings) to change their approach to supporting safety culture development, thus fostering local transformations in practice and creating an opportunity for staff (and service users) to collectively contribute to local safety culture improvements.

Background

Recent health inquiries and reports have identified the central role of safety culture in contributing to healthcare failures within maternity and neonatal services. Our research took a novel safety culture-as-practice approach to explicate how ordinary, taken-for granted practices as a category of analysis (i.e., safety huddles, handover) can provide a potential ‘window’ for staff to understand and harness transformative possibilities for local, small-scale safety culture improvements.

Research

This impact story draws on the findings from NHS England commissioned research on ‘Enabling Safety Culture Development Practices across maternity and neonatal care’ (2021-2). We undertook scoping interviews with strategic leads from 10 NHS organisations in England with high safety culture scores. We then purposively sampled four of these as ‘information rich’ case studies and undertook interviews with local clinical/safety leads, and focus groups with clinical staff. Analysis drew on the constant comparative approach
combined with a theoretical-focused coding framework.

Findings

We found that leaders and teams from Trusts with high safety culture scores reported being sensitive to their local safety cultures and actively tailored efforts to shape cultural change in line with their own work environments. This reflects a growing acknowledgement that generic, ‘top down’ improvement initiatives (where efforts have tended to focus) can only go so far, and that locally driven initiatives predicated on local knowledge and resources may hold the key to ongoing and sustainable improvement over time. Whilst a number of participants reported actively trying to support and enact shared values through new routines or changes to existing practices, many staff also struggled to articulate/explicate the link between values, practices and culture and to practically operationalise safety culture into local level improvements.

Further work is planned for 2025 within the Greater Manchester PSRC Enhancing Cultures of Safety theme to explore the transferability of MOMENTS to other settings, with different forms of implementation support. The resource will be piloted at University Hospitals of Leicester NHS Trust, within the surgical directorate, and a qualitative evaluation of fit, engagement, implementation, and impact will be conducted, involving workshops, focus groups, observations of MOMENTS in use, and interviews with staff involved in the pilot.