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PP.0016. What is asking for help like for staff working in maternity services? Research abstract

journal contribution
posted on 2023-08-11, 15:04 authored by Helen Elliott-Mainwaring, Nicola Mackintosh, Nicola Bateman

Intro: This qualitative thesis has taken an interdisciplinary social science approach to the areas of business and healthcare to explore staff experiences of the digitalisation of specific escalation visual management tools (VMTs). Maternity services in the English National Health Service (NHS) have been used as a setting, and three familiar escalation VMTs have been employed as a focus for qualitative inquiry: Early warning scores (EWS); Sepsis; and Situation, Background, Assessment, Recommendation (SBAR).

Objective: The objective of this research has been to explore how maternity healthcare staff experience escalation in practice, and to pragmatically review how policies and reports align with practice to open a conversational space about future safety in maternity services in England.

Design: The cohort of maternity healthcare staff were broadly representative of the multi-disciplinary team (MDT) and recruited through social media in the weeks following publication of The Ockenden Report. Staff were motivated to contribute with employee voices on the topic of escalation.

Method: Human Factors (HF) and VMT elements were explored using Carayon et al's Systems Engineering Initiative for Patient Safety (SEIPS). Analysis was taken from three workflows: 55 Work as Disclosed qualitative staff interviews; 17 Work as Imagined policy and guideline documents; 20 Work as Reported national reports, applying Shorrock's Varieties of Human Work Theory.

Results: Representations of the messy reality of escalation in maternity services are revealed to appreciate the dissonance in workflow findings. This research evidenced management failures to listen to staff and understand their everyday experiences of working, alongside inadequate and poorly maintained equipment. There was also evidence from a few participants who were comfortable with digitalisation, and this non-uniformity adds depth to the overall findings. This research identified that an inherent tension exists in healthcare digitalisation, between management layers of accountability and creating a manageable clinical workload.

Conclusion: The findings echo issues of working with VMTs outside of healthcare. The importance of colour for staff in decision making was overwhelming. Recommendations are made within the research findings for adjustments to the design and implementation of escalation VMTs to be more closely aligned with staff needs. Future improvement research is suggested for quality, safety, and efficiency within maternity ‘work systems’ in line with Industry 5.0 standards of digital wellness. Including within this are considerations of the concept of Eudaimonia, or staff wellbeing in healthcare, to improve working culture and therefore future safety and system sustainability.


Author affiliation

School of Healthcare, University of Leicester


  • VoR (Version of Record)

Published in

BJOG (British Journal of Obstetrics and Gynaecology)




S2 Special Issue: Top Scoring Abstracts of the RCOG World Congress 2023




Wiley online





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