Working to support cultures of safety in maternity and neonatal services: a qualitative interview study with service leaders and unit/safety leads

Background
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.
Aims
To explore how staff in middle-management positions worked to influence safety cultures at local
maternity and neonatal unit and service level.
Methods
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.
Findings
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.