Learning from Beacon Sites for optimal maternity care: A Safety I/Safety II approach

Development work questions: What outcome measures (specific, measurable, acceptable, feasible and time-relevant) related to the four criteria (clinical and psychological outcomes for service users, staff wellbeing, and use of resources) are important to stakeholders, including service users?

What initial programme theories are considered to explain how high-performing maternity units operate and do they reflect the outcomes measures value to the project stakeholders?

What is the evidence relating to the characteristics and process variables that explain the mechanisms of effect underpinning safe, high-quality, personalised organisations?

What instruments have been proposed to measure these aspects, and can these be synthesised into one assessment tool to differentiate between high and low performing units?

Background Persistent failings in UK maternity services continue to be highlighted with several Public Inquiries generating a multitude of national practice recommendations and changes based on specific cases of error or adverse events - known as a Safety I approach.

There is a risk, however, that implementation of Safety I-type recommendations based on case studies of failure in one context might change the conditions in which other units succeed, with the risk of further failure in future. An alternative would be to also make recommendations based on success, as well as failure.

This has become known as a Safety-II approach.

Safety II is a new and emerging field, yet to be widely applied to maternity services, as such, a novel way to reconsider wider, national improvements.

Therefore, this investigation aims to draw on Safety II principles to explore potential underlying mechanisms of effect that underpin high-performing maternity and neonatal services in England.

Aim This project aims to complete the necessary developmental work to establish potential underlying mechanisms of effect that underpin high-performing maternity and neonatal services in England.

This will inform the development and implementation of a Beacon Sites Programme of best practices to improve performance and outcomes around the country via a Programme Grant (PG).

In essence, this Programme Development Grant (PDG) proposes to build theory from the existing literature (and to identify any gaps), along with stakeholder input that will inform theory testing and an implementation package based on those findings in a future PG. Objectives 1. Establish a PPI, professional, governmental and organisational stakeholder group. 2.

With stakeholder input, identify key outcome measures related to the four criteria (above) of high-performing units that are most important. 3.

To systematically identify, evaluate and synthesise existing knowledge about the characteristics, process variables, mechanisms and related instruments that have been proposed to underpin safe, high-quality, maternity units to develop and refine a theory of what works and why. Identify gaps if any. 4.

Using insights from previous steps, develop an assessment tool with stakeholder input to identify high-performing units. 5. To design another research study to test the assessment tool. 6. To develop and apply for a Programme Grant application. 7. To disseminate synthesis findings. Timeline for delivery Developmental work will be carried out during May 2024 and July 2025.