Sinni Suzanne V, Wallace Euan M, Cross Wendy M
The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University and MIMR-PHI Institute of Medical Research, 246 Clayton Road, Clayton, Victoria, 3168, Australia.
School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia.
BMC Health Serv Res. 2014 Nov 28;14:591. doi: 10.1186/s12913-014-0591-4.
Ensuring safe and appropriate service delivery is central to a high quality maternity service. With this in mind, over recent years much attention has been given to the development of evidence-based clinical guidelines, staff education and risk reporting systems. Less attention has been given to assessing staff perceptions of a service's safety and quality and what factors may influence that. In this study we set out to assess staff perceptions of safety and quality of a maternity service and to explore potential influences on service safety.
The study was undertaken within a new low risk metropolitan maternity service in Victoria, Australia with a staffing profile comprising midwives (including students), neonatal nurses, specialist obstetricians, junior medical staff and clerical staff. In depth open-ended interviews using a semi-structured questionnaire were conducted with 23 staff involved in the delivery of perinatal care, including doctors, midwives, nurses, nursing and midwifery students, and clerical staff. Data were analyzed using naturalistic interpretive inquiry to identify emergent themes.
Staff unanimously reported that there were robust systems and processes in place to maintain safety and quality. Three major themes were apparent: (1) clinical governance, (2) dominance of midwives, (3) inter-professional relationships. Overall, there was a strong sense that, at least in this midwifery-led service, midwives had the greatest opportunity to be an influence, both positively and negatively, on the safe delivery of perinatal care. The importance of understanding team dynamics, particularly mutual respect, trust and staff cohesion, were identified as key issues for potential future service improvement.
Senior staff, particularly midwives and neonatal nurses, play central roles in shaping team behaviors and attitudes that may affect the safety and quality of service delivery. We suggest that strategies targeting senior staff to enhance their performance in their roles, particularly in the training and teamwork role-modeling of the transitory junior workforce, are important for the development and maintenance of a high quality and safe maternity service.
确保安全且恰当的服务提供是高质量产科服务的核心。鉴于此，近年来人们对循证临床指南、员工教育和风险报告系统的发展给予了诸多关注。而对于评估员工对服务安全性和质量的看法以及哪些因素可能影响这些看法的关注则较少。在本研究中，我们旨在评估员工对产科服务安全性和质量的看法，并探讨对服务安全的潜在影响因素。
该研究在澳大利亚维多利亚州一家新的低风险都市产科服务机构内进行，其员工构成包括助产士（含学生）、新生儿护士、专科产科医生、初级医务人员和文职人员。我们使用半结构化问卷对23名参与围产期护理的员工进行了深度开放式访谈，这些员工包括医生、助产士、护士、护理和助产专业学生以及文职人员。采用自然主义解释性探究方法对数据进行分析，以确定浮现的主题。
员工一致报告称，存在健全的系统和流程来维持安全性和质量。出现了三个主要主题：（1）临床治理；（2）助产士的主导地位；（3）跨专业关系。总体而言，大家强烈感觉到，至少在这个以助产士为主导的服务机构中，助产士对围产期护理的安全分娩有着最大的机会产生积极或消极的影响。理解团队动态，特别是相互尊重、信任和员工凝聚力的重要性，被确定为未来潜在服务改进的关键问题。
高级员工，特别是助产士和新生儿护士，在塑造可能影响服务提供安全性和质量的团队行为和态度方面发挥着核心作用。我们建议，针对高级员工的策略，以提高他们在其角色中的表现，特别是在对过渡性初级员工的培训和团队合作示范方面，对于高质量和安全的产科服务的发展和维持至关重要。
