Mackintosh Nicola, Chew Sarah, Armstrong Natalie, Duncan Phil, Hill Matt, Kelly Tony, Sutton Liz, Willars Janet, Tarrant Carolyn
Department of Population Health Sciences, College of Life Sciences, University of Leicester, George Davies Centre, University Road, Leicester, LE1 7RH, UK; National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration (GM PSRC), The University of Manchester, Manchester, M13 9PL, UK.
Department of Population Health Sciences, College of Life Sciences, University of Leicester, George Davies Centre, University Road, Leicester, LE1 7RH, UK.
Midwifery. 2025 Sep;148:104461. doi: 10.1016/j.midw.2025.104461. Epub 2025 May 17.
Recent inquiries have demonstrated the significance of safety cultures within maternity and neonatal services. Research has highlighted the benefits of shifting attention away from safety incidents and towards learning about how the mundane, 'normal' accomplishments of safety are shaped by local cultures. However, we still have much to learn about the role of different staff groups in creating conditions that nurture and sustain local safety cultures.
To explore how staff in middle-management positions worked to influence safety cultures at local maternity and neonatal unit and service level.
We used a qualitative design, starting with scores obtained from a safety culture survey to identify high-performing organisations in England, in line with a positive deviance approach. Thirteen service leads and 23 unit/safety leads participated in interviews. Analysis used the constant comparative approach, combined with a theoretically-focused coding framework.
Our research revealed how service and unit/safety leads influenced their local cultures of safety: through working across boundaries between the executive board and frontline practice on maternity and neonatal safety priorities; engaging with the service user voice, bringing this into the boardroom and the ward; and using horizon-scanning and political connections to manage the interface between policy initiatives and local practice.
Staff in middle-management roles play an important role in nurturing and sustaining local cultures of safety, through boundary working within and outside the organisation and with different stakeholders. This demonstrates the importance of supporting staff in such roles, in efforts to develop local safety cultures.
PROBLEM: problematic cultures/sub-cultures are acknowledged as a contributing factor to failures within healthcare services What is already known: research has highlighted the benefits of shifting attention away from safety incidents and 'extraordinary events', and towards learning how the mundane, 'normal' accomplishments of safety are shaped by local cultures What this paper adds: this paper highlights the important boundary work that staff in middle-management positions undertake to create the conditions that nurture and sustain local safety cultures.
近期调查表明了产科和新生儿服务中安全文化的重要性。研究强调了将注意力从安全事件转移到了解当地文化如何塑造日常“正常”安全成就的益处。然而，我们对于不同员工群体在创造培育和维持当地安全文化条件方面所起的作用仍有许多需要了解的地方。
探讨中层管理岗位的员工如何努力影响当地产科和新生儿科室及服务层面的安全文化。
我们采用定性设计，从安全文化调查获得的分数入手，按照积极偏差方法确定英国的高绩效组织。13名服务主管和23名科室/安全主管参与了访谈。分析采用持续比较法，并结合以理论为重点的编码框架。
我们的研究揭示了服务主管和科室/安全主管如何影响其当地的安全文化：通过在执行董事会和产科及新生儿安全优先事项的一线实践之间跨越界限开展工作；倾听服务使用者的声音，将其带入董事会和病房；利用前瞻性扫描和政治联系来管理政策举措与当地实践之间的衔接。
中层管理岗位的员工通过在组织内外与不同利益相关者开展界限工作，在培育和维持当地安全文化方面发挥着重要作用。这表明在努力发展当地安全文化时，支持此类岗位员工的重要性。
问题：不良文化/亚文化被认为是医疗服务失败的一个促成因素 已知信息：研究强调了将注意力从安全事件和“特殊事件”转移，转向了解当地文化如何塑造日常“正常”安全成就的益处 本文补充内容：本文强调了中层管理岗位员工为创造培育和维持当地安全文化的条件而进行的重要界限工作。
