Simms Rebecca A, Yelland Andrew, Ping Helen, Beringer Antonia J, Draycott Timothy J, Fox Robert
Department of Women's Health, North Bristol NHS Trust, Bristol, UK School of Clinical Sciences, University of Bristol, Bristol, UK.
Faculty of Health and Life Sciences, University of the West of England, Bristol, UK.
BMJ Qual Saf. 2014 Jun;23(6):457-64. doi: 10.1136/bmjqs-2013-002025. Epub 2013 Dec 6.
Risk management is a core part of healthcare practice, especially within maternity services, where litigation and societal costs are high. There has been little investigation into the experiences and opinions of those staff directly involved in risk management: lead obstetricians and specialist risk midwives, who are ideally placed to identify how current implementation of risk management strategies can be improved.
A qualitative study of consultant-led maternity units in an English region. Semistructured interviews were conducted with the obstetric and midwifery risk management leads for each unit. We explored their approach to risk management, particularly their opinions regarding quality monitoring and related barriers/issues. Interviews were recorded, transcribed and thematically analysed.
Twenty-seven staff from 12/15 maternity units participated. Key issues identified included: concern for the accuracy and validity of their local data, potential difficulties related to data collation, the negative impact of external interference by national regulatory bodies on local clinical priorities, the influence of the local culture of the maternity unit on levels of engagement in the risk management process, and scepticism about the value of benchmarking of maternity units without adjustment for population characteristics.
Local maternity risk managers may provide valuable, clinically relevant insights into current issues in clinical data monitoring. Improvements should focus on the accuracy and ease of data collation with a need for an agreed maternity indicators set, populated from validated databases, and not reliant on data collection systems that distract clinicians from patient activity and quality improvement. It is clear that working relationships between risk managers, their own clinical teams and external national bodies require improvement and alignment. Further discussion regarding benchmarking between maternity units is required prior to implementation. These findings are likely to be relevant to other clinical specialties.
风险管理是医疗实践的核心部分，在产科服务领域尤为如此，因为该领域的诉讼和社会成本很高。对于直接参与风险管理的人员，即产科主任和专科风险助产士的经验和意见，几乎没有进行过调查，而他们最有条件确定如何改进当前风险管理策略的实施情况。
对英国一个地区由顾问主导的产科病房进行定性研究。对每个病房的产科和助产风险管理负责人进行了半结构化访谈。我们探讨了他们的风险管理方法，特别是他们对质量监测及相关障碍/问题的看法。访谈进行了录音、转录并进行了主题分析。
来自15个产科病房中的12个病房的27名工作人员参与了研究。确定的关键问题包括：对当地数据准确性和有效性的担忧、与数据整理相关的潜在困难、国家监管机构的外部干预对当地临床重点的负面影响、产科病房当地文化对风险管理过程参与程度的影响，以及对在不考虑人群特征的情况下对产科病房进行基准比较的价值表示怀疑。
当地产科风险管理人员可能会对临床数据监测中的当前问题提供有价值的、与临床相关的见解。改进应侧重于提高数据整理的准确性和便捷性，需要一套商定的产科指标，这些指标应来自经过验证的数据库，而不是依赖那些使临床医生从患者活动和质量改进工作中分心的数据收集系统。显然，风险管理人员与其自身临床团队以及外部国家机构之间的工作关系需要改进和协调。在实施之前，需要就产科病房之间的基准比较进行进一步讨论。这些发现可能与其他临床专科相关。
