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Nafeh NA, El Khoury FM, Khalili A, Zeeni C, Karaki GA, Mroueh R, HajAli T, Siddik-Sayyid S. Insights into obstetric anesthesia practices: a quantitative survey among physicians across Arab countries. BMC Anesthesiol 2024; 24:341. [PMID: 39342099 PMCID: PMC11437647 DOI: 10.1186/s12871-024-02728-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Accepted: 09/13/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND Obstetric anesthesia guidelines are essential for standardizing obstetric anesthesia practices globally and ensuring high-quality patient care. However, practices may vary across different settings, and there are limited data from Arab countries. This study aims to gain insights into obstetric anesthesia practices in several major hospitals across Arab countries. METHODS A questionnaire was emailed to 85 obstetric anesthesiologists/anesthesia chairpersons in major hospitals, including academic medical institutions and central hospitals, across 11/22 Arab countries. This survey gathered data on key structural and process-related obstetric anesthesia indicators. RESULTS Out of 85 contacted, we had 56 responses (65.8%), with 41 being fully completed, providing insights into obstetric anesthesia indicators. Regarding structure: 31 (76%) hospitals had an operating room adjacent to the delivery room, all had intensive care units, and 22 (54%) had a lead obstetric anesthesiologist. For equipment, 19 (46%) had a video laryngoscope in the delivery suite, and 20 (49%) occasionally used ultrasound for epidurals. Regarding process: 33 (81%) held regular meetings, and 21 (51%) conducted research. Before epidural and spinal procedures, 26 (63%) and 28 (68%) required coagulation studies for patients without a history of hemorrhagic complications, while 38 (93%) and 36 (88%) mandated a platelet count, respectively. For labor analgesia, 34 (83%) primarily used epidurals, and 15 (37%) placed preemptive catheters in high-risk pregnancies. For cesarean delivery, 40 (98%) used spinals, with 16 (39%) using intrathecal morphine and 22 (54%) administering aspiration prophylaxis before general anesthesia. Regarding spinal-induced hypotension, 6 (15%) used prophylactic phenylephrine infusion. CONCLUSION This survey highlights variations in obstetric anesthesia practices among various major hospitals in several Arab countries, compared to international recommendations. It emphasizes the need for obstetric anesthesia registries in the Arab world for future research. Further studies are required to outline country-specific practices, improve resource allocation, and enhance obstetric population safety and satisfaction.
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Affiliation(s)
- Nancy Abou Nafeh
- Department of Anesthesiology and Pain Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fatima Msheik El Khoury
- Department of Anesthesiology and Pain Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Amro Khalili
- Department of Anesthesiology and Pain Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Carine Zeeni
- Department of Anesthesiology and Pain Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Gloria Al Karaki
- Department of Anesthesiology and Pain Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Raghad Mroueh
- Department of Anesthesiology and Pain Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Thuraya HajAli
- Department of Anesthesiology and Pain Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sahar Siddik-Sayyid
- Department of Anesthesiology and Pain Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Aggarwal A, Simcock R, Price P, Rachet B, Lyratzopoulos G, Walker K, Spencer K, Roques T, Sullivan R. NHS cancer services and systems-ten pressure points a UK cancer control plan needs to address. Lancet Oncol 2024; 25:e363-e373. [PMID: 38991599 DOI: 10.1016/s1470-2045(24)00345-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/12/2024] [Accepted: 06/13/2024] [Indexed: 07/13/2024]
Abstract
In this Policy Review we discuss ten key pressure points in the NHS in the delivery of cancer care services that need to be urgently addressed by a comprehensive national cancer control plan. These pressure points cover areas such as increasing workforce capacity and its productivity, delivering effective cancer survivorship services, addressing variation in quality, fixing the reimbursement system for cancer care, and balancing of the cancer research agenda. These areas have been selected based on their relative importance to ensuring sustainable cancer services, persistence as key issues in the NHS, and their impact on delivering better and more equitable and affordable patient outcomes. Many of these pressure points are not acknowledged explicitly in any current discourse. The evidence we provide points to their impact on the ability to deliver world class cancer care, but also to their amenability to affordable solutions if given the relevant prioritisation and investment. The current narrative needs to move away from a technocentric approach to improving care, to one focused on understanding the complexity of cancer services and the wider health system to drive improvements in survival, quality of life, and experience for patients.
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Affiliation(s)
- Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; Department of Oncology, Guy's & St Thomas' NHS Trust, London, UK.
| | - Richard Simcock
- Department of Oncology, University Hospitals Sussex NHS Trust, Brighton, UK
| | - Pat Price
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Bernard Rachet
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Kate Walker
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Katie Spencer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK; Department of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Tom Roques
- Department of Oncology, Norfolk and Norwich NHS Foundation Trust, Norwich, UK
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Dooley J, Jardine J, Ibrahim B, Mongru R, Pradhan F, Wolstenholme D, Lenguerrand E, Draycott T, Bruce F, Iliodromiti S. A positive deviant approach to examining the impact of Covid-19 on ethnic inequalities in maternal and neonatal outcomes. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 40:100971. [PMID: 38692137 DOI: 10.1016/j.srhc.2024.100971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/08/2024] [Accepted: 04/17/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVES During the COVID-19 pandemic, rapid and heterogeneous changes were made to maternity care. Identification of changes that may reduce maternal health inequalities is a national priority. The aim of this project was to use data collected about care and outcomes to identify NHS Trusts in the UK where inequalities in outcomes reduced during the pandemic and explore through interviews how the changes that occurred may have led to a reduction in inequalities. METHODS A Women's Reference Group of public advisors guided the project. Analysis of Hospital Episode Statistics Admitted Patient Care data of 128 organisations in England identified "positive deviant" organisations that reduced inequalities, using maternal and perinatal composite adverse outcome indicators. Positive deviant organisations were identified for investigation, alongside comparators. Senior clinicians, heads of midwifery and representatives of women giving birth were interviewed. Reflexive thematic analysis was employed. RESULTS The change in the inequality gap for the maternal indicator ranged from a reduction of -0.24 to an increase of 0.30 per 1000 births between the pre-pandemic and pandemic period. For the perinatal composite indicator, the change in inequality gap ranged from -0.47 to 0.67 per 1000 births. Nine Trusts were identified as positive deviants and 10 as comparators. We conducted 20 interviews from six positive deviant and four comparator organisations. Positive deviants reported that necessary shifts in roles led to productive and novel use of expert staff; comparators reported senior staff 'stepping in' where needed and no benefits of this. They reported proactivity and quick reactions, increased team working, and rapid implementation of new ideas. Comparators found constant changes overwhelming, and no increase in team working. No specific differences in care processes were identified. CONCLUSIONS Harnessing proactivity, flexibility, staffing resource, and increased team working proves vital in reducing health inequalities.
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Affiliation(s)
- Jemima Dooley
- Clinical Quality, Royal College of Obstetrics and Gynaecologists, 10-18 Union Street, London, SE11GH, UK.
| | - Jen Jardine
- Clinical Quality, Royal College of Obstetrics and Gynaecologists, 10-18 Union Street, London, SE11GH, UK
| | - Buthaina Ibrahim
- Clinical Quality, Royal College of Obstetrics and Gynaecologists, 10-18 Union Street, London, SE11GH, UK
| | - Rohan Mongru
- Clinical Quality, Royal College of Obstetrics and Gynaecologists, 10-18 Union Street, London, SE11GH, UK
| | - Farrah Pradhan
- Clinical Quality, Royal College of Obstetrics and Gynaecologists, 10-18 Union Street, London, SE11GH, UK
| | - Daniel Wolstenholme
- Clinical Quality, Royal College of Obstetrics and Gynaecologists, 10-18 Union Street, London, SE11GH, UK
| | - Erik Lenguerrand
- Musculoskeletal Research Unit, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, BS10 5NB, UK
| | - Tim Draycott
- Clinical Quality, Royal College of Obstetrics and Gynaecologists, 10-18 Union Street, London, SE11GH, UK
| | - Faye Bruce
- Caribbean and African Health Network, Transformation Community Resource Centre, 1st Floor, Richmond House, 11 Richmond Grove, Manchester, M13 0LN, UK
| | - Stamatina Iliodromiti
- Women's Health Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Ferguson J, Stringer G, Walshe K, Allen T, Grigoroglou C, Ashcroft DM, Kontopantelis E. Locum doctor working and quality and safety: a qualitative study in English primary and secondary care. BMJ Qual Saf 2024; 33:354-362. [PMID: 38627099 PMCID: PMC11103325 DOI: 10.1136/bmjqs-2023-016699] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/12/2023] [Indexed: 05/19/2024]
Abstract
BACKGROUND The use of temporary doctors, known as locums, has been common practice for managing staffing shortages and maintaining service delivery internationally. However, there has been little empirical research on the implications of locum working for quality and safety. This study aimed to investigate the implications of locum working for quality and safety. METHODS Qualitative semi-structured interviews and focus groups were conducted with 130 participants, including locums, patients, permanently employed doctors, nurses and other healthcare professionals with governance and recruitment responsibilities for locums across primary and secondary healthcare organisations in the English NHS. Data were collected between March 2021 and April 2022. Data were analysed using reflexive thematic analysis and abductive analysis. RESULTS Participants described the implications of locum working for quality and safety across five themes: (1) 'familiarity' with an organisation and its patients and staff was essential to delivering safe care; (2) 'balance and stability' of services reliant on locums were seen as at risk of destabilisation and lacking leadership for quality improvement; (3) 'discrimination and exclusion' experienced by locums had negative implications for morale, retention and patient outcomes; (4) 'defensive practice' by locums as a result of perceptions of increased vulnerability and decreased support; (5) clinical governance arrangements, which often did not adequately cover locum doctors. CONCLUSION Locum working and how locums were integrated into organisations posed some significant challenges and opportunities for patient safety and quality of care. Organisations should take stock of how they work with the locum workforce to improve not only quality and safety but also locum experience and retention.
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Affiliation(s)
- Jane Ferguson
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Gemma Stringer
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Kieran Walshe
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Thomas Allen
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
- Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | - Christos Grigoroglou
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- NIHR Greater Manchester Patient Safety Research Collaboration (PSRC), Division of Pharmacy and Optometry, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Evangelos Kontopantelis
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
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Arnold R, van Teijlingen E, Way S, Mahato P. 'I might have cried in the changing room, but I still went to work'. Maternity staff balancing roles, responsibilities, and emotions of work and home during COVID-19: An appreciative inquiry. Women Birth 2024; 37:128-136. [PMID: 37567851 DOI: 10.1016/j.wombi.2023.07.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 08/13/2023]
Abstract
PROBLEM Knowing how to help staff thrive and remain in practice in maternity services. BACKGROUND A chronic shortage of staff in maternity services in the United Kingdom and high levels of stress and burnout in midwifery and medical staff. PURPOSE To understand how to support and enhance the wellbeing of staff in a small UK maternity service. METHODS An appreciative inquiry using interviews with n = 39 maternity staff and n = 4 group discussions exploring meaningful experiences, values and factors that helped their wellbeing. RESULTS Staff members were highly motivated, managing a complex melee of emotions and responsibilities including challenges to professional confidence, mental health, family situation, and conflict between work-life roles. Despite staff shortages, a demanding workload, professional and personal turmoil, and the pandemic participants still found meaning in their work and relationships. DISCUSSION A 'whole person' approach provided insight into the multiple stressors and emotional demands staff faced. It also revealed staff resourcefulness in managing their professional and personal roles. They invested in relationships with women but were also aware of their limits - the need to be self-caring, employ strategies to switch-off, set boundaries or keep a protective distance. CONCLUSION Staff wellbeing initiatives, and research into wellbeing, would benefit from adopting a holistic approach that incorporates home and family with work. Research on emotion regulation strategies could provide insights into managing roles, responsibilities, and the emotional demands of working in maternity services. Emotion regulation strategies could be included in midwifery and obstetric training.
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Affiliation(s)
- Rachel Arnold
- Centre for Midwifery and Women's Health, Bournemouth University, Bournemouth, UK.
| | - Edwin van Teijlingen
- Centre for Midwifery and Women's Health, Bournemouth University, Bournemouth, UK
| | - Susan Way
- Centre for Midwifery and Women's Health, Bournemouth University, Bournemouth, UK
| | - Preeti Mahato
- Department of Health Studies, Royal Holloway University of London, London, UK
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McGowan JG, Martin GP, Krapohl GL, Campbell DA, Englesbe MJ, Dimick JB, Dixon-Woods M. What are the features of high-performing quality improvement collaboratives? A qualitative case study of a state-wide collaboratives programme. BMJ Open 2023; 13:e076648. [PMID: 38097243 PMCID: PMC10729078 DOI: 10.1136/bmjopen-2023-076648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES Despite their widespread use, the evidence base for the effectiveness of quality improvement collaboratives remains mixed. Lack of clarity about 'what good looks like' in collaboratives remains a persistent problem. We aimed to identify the distinctive features of a state-wide collaboratives programme that has demonstrated sustained improvements in quality of care in a range of clinical specialties over a long period. DESIGN Qualitative case study involving interviews with purposively sampled participants, observations and analysis of documents. SETTING The Michigan Collaborative Quality Initiatives programme. PARTICIPANTS 38 participants, including clinicians and managers from 10 collaboratives, and staff from the University of Michigan and Blue Cross Blue Shield of Michigan. RESULTS We identified five features that characterised success in the collaboratives programme: learning from positive deviance; high-quality coordination; high-quality measurement and comparative performance feedback; careful use of motivational levers; and mobilising professional leadership and building community. Rigorous measurement, securing professional leadership and engagement, cultivating a collaborative culture, creating accountability for quality, and relieving participating sites of unnecessary burdens associated with programme participation were all important to high performance. CONCLUSIONS Our findings offer valuable learning for optimising collaboration-based approaches to improvement in healthcare, with implications for the design, structure and resourcing of quality improvement collaboratives. These findings are likely to be useful to clinicians, managers, policy-makers and health system leaders engaged in multiorganisational approaches to improving quality and safety.
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Affiliation(s)
- James G McGowan
- The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Graham P Martin
- The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Greta L Krapohl
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Justin B Dimick
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Mary Dixon-Woods
- The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Heys S, Main C, Humphreys A, Torrance R. Displaced risk. Keeping mothers and babies safe: a UK ambulance service lens. Br Paramed J 2023; 8:52-56. [PMID: 37674917 PMCID: PMC10477820 DOI: 10.29045/14784726.2023.9.8.2.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Aim The aim of this professional practice paper is to provide a critical commentary on displaced risk among perinatal and neonatal patients attended to by the ambulance service. Background NHS services across the United Kingdom are currently facing unprecedented demand and increased scrutiny in their ability to provide safe and personalised care to patients. While current focus in the system centres around addressing social care demand, hospital bed capacity, planned care waiting times, staffing and ambulance handover delays, a less explored cohort of patients impacted by the current healthcare crisis is perinatal and neonatal populations attended to by the ambulance service. Little focus has been paid within national agendas to the care provided to women and babies outside of planned maternity and obstetric care. A case is presented to highlight the importance of considering urgent and emergency maternity care provision provided by the ambulance service, and the impact of 'displaced risk' due to the current pressures within healthcare systems. Conclusion Placed in a national context, drawing upon current independent reviews into maternity services, national transformation agendas and the most recent MBRRACE-UK confidential enquiry into maternal deaths and morbidity, a case is made to commissioners and Integrated Care Systems to focus on and invest in the unplanned pre-hospital care of maternity and neonatal patients. Recognition of the ambulance service as a key provider of care to this cohort of patients is paramount, calling on services and systems to work together on realising and addressing displaced risk for perinatal populations across the United Kingdom. A system approach that acknowledges the need for high-quality care at every point of contact and equitability in access to services for pregnant, postpartum and neonatal patients is vital.
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Affiliation(s)
- Stephanie Heys
- North West Ambulance Service NHS Trust; University of Central Lancashire https://orcid.org/0000-0002-4379-9022
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Wanyama C, Blacklock C, Jepkosgei J, English M, Hinton L, McKnight J, Molyneux S, Boga M, Musitia PM, Wong G. Protocol for the Pathways Study: a realist evaluation of staff social ties and communication in the delivery of neonatal care in Kenya. BMJ Open 2023; 13:e066150. [PMID: 36914188 PMCID: PMC10016238 DOI: 10.1136/bmjopen-2022-066150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 02/22/2023] [Indexed: 03/14/2023] Open
Abstract
INTRODUCTION The informal social ties that health workers form with their colleagues influence knowledge, skills and individual and group behaviours and norms in the workplace. However, improved understanding of these 'software' aspects of the workforce (eg, relationships, norms, power) have been neglected in health systems research. In Kenya, neonatal mortality has lagged despite reductions in other age groups under 5 years. A rich understanding of workforce social ties is likely to be valuable to inform behavioural change initiatives seeking to improve quality of neonatal healthcare.This study aims to better understand the relational components among health workers in Kenyan neonatal care areas, and how such understanding might inform the design and implementation of quality improvement interventions targeting health workers' behaviours. METHODS AND ANALYSIS We will collect data in two phases. In phase 1, we will conduct non-participant observation of hospital staff during patient care and hospital meetings, a social network questionnaire with staff, in-depth interviews, key informant interviews and focus group discussions at two large public hospitals in Kenya. Data will be collected purposively and analysed using realist evaluation, interim analyses including thematic analysis of qualitative data and quantitative analysis of social network metrics. In phase 2, a stakeholder workshop will be held to discuss and refine phase one findings.Study findings will help refine an evolving programme theory with recommendations used to develop theory-informed interventions targeted at enhancing quality improvement efforts in Kenyan hospitals. ETHICS AND DISSEMINATION The study has been approved by Kenya Medical Research Institute (KEMRI/SERU/CGMR-C/241/4374) and Oxford Tropical Research Ethics Committee (OxTREC 519-22). Research findings will be shared with the sites, and disseminated in seminars, conferences and published in open-access scientific journals.
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Affiliation(s)
- Conrad Wanyama
- Health Systems and Research Ethics, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Claire Blacklock
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Juliet Jepkosgei
- Health Systems and Research Ethics, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Mike English
- Health Systems and Research Ethics, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine and Department of Paediatrics, Univerity of Oxford Nuffield Department of Medicine, Oxford, UK
| | - Lisa Hinton
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| | - Jacob McKnight
- Tropical Medicine, University of Oxford Nuffield Department of Medicine, Oxford, UK
- University of Oxford Nuffield Department of Clinical Medicine, Oxford, UK
| | - Sassy Molyneux
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Centre for Geographic Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Mwanamvua Boga
- Centre for Geographic Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Peris Muoga Musitia
- Health Services Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
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Developing the midwifery Unit Self-Assessment (MUSA) Framework: A mixed methods study in six European midwifery units. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 35:100819. [PMID: 36822025 DOI: 10.1016/j.srhc.2023.100819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Evidence indicates that midwifery units are associated with improved health outcomes and experiences; however, there are barriers to their development and scale-up. Guidelines are crucial to their implementation, ensuring that they are developed and integrated sustainably and safely. This study aimed to evaluate and explore the use of a self-assessment tool and improvement process for midwifery units in Europe. METHODS A mixed methods study was conducted with six midwifery units located in Europe. Quantitative and qualitative data were collected and analysed concurrently, and each informed the other, making the approach both interactive and iterative. The six midwifery units were invited to complete the self-assessment tool, the responses of which were analysed descriptively, and implement an improvement process into practice. Interviews were conducted with midwives using the tool and analysed thematically. RESULTS Findings indicate benefits and potential feasibility of an improvement process for midwifery units, and suggest that the self-assessment tool is a generative and reflexive practice for midwives. However, issues were identified around limitations of the tool, structural barriers and professional autonomy. Midwifery units require a framework to guide and support their implementation, improvement and scale-up. CONCLUSION Results highlight the need for more consideration of how macro-level barriers, encompassing social, legal and political dimensions of maternity care, factor locally in the implementation and scale-up of midwifery units. More research is needed to evaluate the feasibility and outcomes of implementing a self-assessment and improvement framework in midwifery units across Europe.
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Bamber JH, Lucas DN, Russell R. The delivery of obstetric anaesthetic care in UK maternity units: a survey of practice in 2021. Int J Obstet Anesth 2023; 53:103618. [PMID: 36681016 DOI: 10.1016/j.ijoa.2022.103618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 11/27/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Anaesthetists are crucial members of the maternity unit team, providing peri-operative analgesia and anaesthesia, and supporting the delivery of medical care to high-risk women. The effective contribution from obstetric anaesthetists to safety in maternity units depends on how anaesthesia services are organised and resourced. There is a lack of information on how obstetric anaesthetic care is resourced in the UK. METHODS The Obstetric Anaesthetists' Association surveyed UK clinical leads for their hospital's obstetric anaesthetic service and examined compliance with national recommendations. RESULTS There were 153 responses by lead obstetric anaesthetists from 184 maternity units in the UK (83%). The number of consultants per 1000 deliveries was 2.2 [1.6-2.7] (median [IQR]). In 20% of units, there was a dedicated on-call rota (on-call only for obstetric anaesthesia), whilst the remainder had a 'combined' on-call rota (on-call for other clinical areas in addition to obstetrics). Multidisciplinary ward rounds were held in 83% of units. Twenty-five (16%) units reported having no regular multidisciplinary ward rounds, of which nine (6%) did not have any multidisciplinary ward rounds. Planned operating lists for elective caesarean sections were provided in 77% of units. CONCLUSIONS In the largest survey of obstetric anaesthesia workload to be reported for any health system, we found significant disparities between obstetric anaesthesia service provision and current national recommendations for areas including consultant staffing, support for elective caesarean section lists, antenatal anaesthetic clinics, and consultant support for service development. Wide national variation in service provision was identified.
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Affiliation(s)
- J H Bamber
- Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - D N Lucas
- Department of Anaesthesia, London North West University Healthcare NHS Trust, London, UK.
| | - R Russell
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Eller S, Rudolph J, Barwick S, Janssens S, Bajaj K. Leading change in practice: how "longitudinal prebriefing" nurtures and sustains in situ simulation programs. ADVANCES IN SIMULATION (LONDON, ENGLAND) 2023; 8:3. [PMID: 36681827 PMCID: PMC9862849 DOI: 10.1186/s41077-023-00243-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 01/12/2023] [Indexed: 01/22/2023]
Abstract
In situ simulation (ISS) programs deliver patient safety benefits to healthcare systems, however, face many challenges in both implementation and sustainability. Prebriefing is conducted immediately prior to a simulation activity to enhance engagement with the learning activity, but is not sufficient to embed and sustain an ISS program. Longer-term and broader change leadership is required to engage colleagues, secure time and resources, and sustain an in situ simulation program. No framework currently exists to describe this process for ISS programs. This manuscript presents a framework derived from the analysis of three successful ISS program implementations across different hospital systems. We describe eight change leadership steps adapted from Kotter's change management theory, used to sustainably implement the ISS programs analyzed. These steps include the following: (1) identifying goals of key stakeholders, (2) engaging a multi-professional team, (3) creating a shared vision, (4) communicating the vision effectively, (5) energizing participants and enabling program participation, (6) identifying and celebrating early success, (7) closing the loop on early program successes, and (8) embedding simulation in organizational culture and operations. We describe this process as a "longitudinal prebrief," a framework which provides a step-by-step guide to engage colleagues and sustain successful implementation of ISS.
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Affiliation(s)
- Susan Eller
- grid.168010.e0000000419368956Immersive Learning and Learning Spaces, Center for Immersive and Simulation-Based Learning, School of Medicine, Stanford University, 291 Campus Drive, Stanford, CA LK311B USA
| | - Jenny Rudolph
- grid.32224.350000 0004 0386 9924Surgery, Health Professions Education, Center for Medical Simulation, Harvard Medical School, Massachusetts General Hospital-Institute for Health Professions, Boston, MA USA
| | - Stephanie Barwick
- Clinical Education, Mater Education, Mater Misericordiae, Brisbane, Australia
| | - Sarah Janssens
- Obstetrics and Gynaecology, Clinical Simulation, Mater Health, Mater Misericordiae, Brisbane, Australia
| | - Komal Bajaj
- grid.251993.50000000121791997Obstetrics & Gynecology and Women’s Health, Department of Quality & Safety, NYC H+H Simulation Center, NYC Health + Hospitals/Jacobi, Albert Einstein College of Medicine, Bronx, NY USA
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Goldman J, Rotteau L, Flintoft V, Jeffs L, Baker GR. Measurement and Monitoring of Safety Framework: a qualitative study of implementation through a Canadian learning collaborative. BMJ Qual Saf 2022:bmjqs-2022-015017. [PMID: 36598000 DOI: 10.1136/bmjqs-2022-015017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 11/04/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Measurement and Monitoring of Safety Framework (MMSF) aims to move beyond a narrow focus on measurement and past harmful events as the major focus for safety in healthcare organisations. There is limited evidence of MMSF implementation and impact. OBJECTIVE We aimed to examine participants' perspectives and experiences to increase understanding of the adaptive work of implementing the MMSF through a learning collaborative programme in diverse healthcare contexts across Canada. METHODS The Collaborative consisted of 11 teams from seven provinces. We conducted a qualitative study involving interviews with 36 participants, observations of 5 sites and learning sessions, and collection of documents. RESULTS Collaborative sessions and coaching allowed participants to explore reliability, sensitivity to operations, anticipation and preparedness, and integration and learning, in addition to past harm, and move beyond a project and measurement oriented safety approach. Participants noted the importance of time dedicated to engaging stakeholders in talk about MMSF concepts and their significance to their settings, prior to moving to implementing the Framework into practice. While participants generally started with a small number of ways of integrating the MMSF into practice such as rounds or huddles, many teams continued to experiment with incorporating the MMSF into a range of practices. Participants reported changes in thinking about safety, discussions and behaviours, which were perceived to impact healthcare processes. However, participants also reported challenges to sharing the Framework broadly and moving beyond its surface implementation, and difficulties with its sustained and widespread use given misalignments with existing quality and safety processes. CONCLUSION The MMSF requires a dramatic departure from traditional safety strategies that focus on discrete problems and emphasise measurement. MMSF implementation requires extensive discussion, coaching and experimentation. Future implementation should consider engaging local leaders and coaches and an organisation or system approach to enable broader reach and systemic change.
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Affiliation(s)
- Joanne Goldman
- Centre for Quality Improvement and Patient Safety, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Leahora Rotteau
- Centre for Quality Improvement and Patient Safety, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Virginia Flintoft
- Health Policy, Management and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Lianne Jeffs
- Health Policy, Management and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada.,Institute for the Science of Care and Innovation, Sinai Health System, Toronto, Ontario, Canada
| | - G Ross Baker
- Health Policy, Management and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
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13
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Aiello E, Perera K, Ade M, Sordé-Martí T. A case study on the use of Public Narrative as a leadership development approach for Patient Leaders in the English National Health Service. Front Public Health 2022; 10:926599. [PMID: 36187684 PMCID: PMC9521407 DOI: 10.3389/fpubh.2022.926599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/15/2022] [Indexed: 01/24/2023] Open
Abstract
Background In 2016 the National Health Service (NHS) England embraced the commitment to work for maternity services to become safer, more personalized, kinder, professional and more family-friendly. Achieving this involves including a service users' organizations to co-lead and deliver the services. This article explores how Public Narrative, a framework for leadership development used across geographical and cultural settings worldwide, can enhance the confidence, capability and skills of service-user representatives (or Patient Leaders) in the National Health Service (NHS) in England. Specifically, we analyse a pilot initiative conducted with one cohort of Patient Leaders, the Chairs of local Maternity Voices Partnerships (MVPs), and how they have used Public Narrative to enhance their effectiveness in leading transformation in maternity services as part of the NHS Maternity Transformation Programme. Methods Qualitative two-phase case study of a pilot training and coaching initiative using Public Narrative with a cohort of MVP Chairs. Phase 1 consisted of a 6-month period, during which the standard framework was adapted in co-design with the MVP Chairs. A core MVP Chair Co-Design Group underwent initial training and follow-up coaching in Public Narrative. Phase 2 consisted of qualitative data collection and data analysis. Results The study of this pilot initiative suggests two main ways in which Public Narrative can enhance the effectiveness of Patient Leaders in service improvement in general and maternity services in specific. First, training and coaching in the Public Narrative framework enables Patient Leaders to gain insight into, articulate and then craft their lived experience of healthcare services in a way that connects with and activates the underlying values of others ("shared purpose"), such that those experiences become an emotional resource on which Patient Leaders can draw to influence future service design and decision-making processes. Second, Public Narrative provides a simple and compelling structure through which Patient Leaders can enhance their skills, confidence and capability as "healthcare leaders," both individually and collectively. Conclusions The Public Narrative framework can significantly enhance the confidence, capability and skills of Patient Leaders, both to identify and coalesce around shared purpose and to advance genuine co-production in the design and improvement of healthcare services in general and maternity services in specific.
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Affiliation(s)
- Emilia Aiello
- Department of Sociology, Autonomous University of Barcelona, Cerdanyola del Vallés, Barcelona, Spain,*Correspondence: Emilia Aiello
| | - Kathryn Perera
- National Health Service (NHS) Horizons, London, United Kingdom
| | - Mo Ade
- Maternity Voices Partnership (MVP) Chair and Patient Public Voice, National Health Service, Ashford, United Kingdom
| | - Teresa Sordé-Martí
- Department of Sociology, Autonomous University of Barcelona, Cerdanyola del Vallés, Barcelona, Spain
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14
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Brazil V, McLean D, Lowe B, Kordich L, Cullen D, De Araujo V, Eldridge T, Purdy E. A relational approach to improving interprofessional teamwork in post-partum haemorrhage (PPH). BMC Health Serv Res 2022; 22:1108. [PMID: 36050714 PMCID: PMC9438096 DOI: 10.1186/s12913-022-08463-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/16/2022] [Indexed: 12/01/2022] Open
Abstract
Background Post-partum haemorrhage (PPH) is an obstetric emergency that requires effective teamwork under complex conditions. We explored healthcare team performance for women who suffered a PPH, focusing on relationships and culture as critical influences on teamwork behaviours and outcomes. Methods In collaboration with clinical teams, we implemented structural, process and relational interventions to improve teamwork in PPH cases. We were guided by the conceptual framework of Relational Coordination and used a mixed methods approach to data collection and analysis. We employed translational simulation as a central, but not singular, technique for enabling exploration and improvement. Key themes were identified from surveys, focus groups, simulation sessions, interviews, and personal communications over a 12-month period. Results Four overarching themes were identified: 1) Teamwork, clear roles and identified leadership are critical. 2) Relational factors powerfully underpin teamwork behaviours—shared goals, shared knowledge, and mutual respect. 3) Conflict and poor relationships can and should be actively explored and addressed to improve performance. 4) Simulation supports improved team performance through multifaceted mechanisms. One year after the project commenced, significant progress had been made in relationships and systems. Clinical outcomes have improved; despite unprecedented increase in labour ward activity, there has not been any increase in large PPHs. Conclusions Teamwork, relationships, and the context of care can be actively shaped in partnership with clinicians to support high performance in maternity care. We present our multifaceted approach as a guide for leaders and clinicians in maternity teams, and as an exemplar for others enacting quality improvement in healthcare.
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Affiliation(s)
| | - Darren McLean
- Gold Coast Hospital and Health Service, Gold Coast, Australia
| | - Belinda Lowe
- Gold Coast Hospital and Health Service, Gold Coast, Australia
| | - Lada Kordich
- Gold Coast Hospital and Health Service, Gold Coast, Australia
| | - Deborah Cullen
- Gold Coast Hospital and Health Service, Gold Coast, Australia
| | | | - Talia Eldridge
- Gold Coast Hospital and Health Service, Gold Coast, Australia
| | - Eve Purdy
- Gold Coast Hospital and Health Service, Gold Coast, Australia
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15
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Blacklock C, Darwin A, English M, McKnight J, Hinton L, Harriss E, Wong G. The social networks of hospital staff: A realist synthesis. J Health Serv Res Policy 2022; 27:242-252. [PMID: 35513308 PMCID: PMC9277319 DOI: 10.1177/13558196221076699] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The social ties people have with one another are known to influence behaviour, and how information is accessed and interpreted. It is unclear, however, how the social networks that exist in multi-professional health care workplaces might be used to improve quality in hospitals. This paper develops explanatory theory using realist synthesis to illuminate the details and significance of the social ties between health care workers. Specifically we ask: How, why, for whom, to what extent and in what context, do the social ties of staff within a hospital influence quality of service delivery, including quality improvement? METHODS From a total of 75 included documents identified through an extensive systematic literature search, data were extracted and analysed to identify emergent explanatory statements. RESULTS The synthesis found that within the hospital workforce, an individual's place in the social whole can be understood across four identified domains: (1) social group, (2) hierarchy, (3) bridging distance and (4) discourse. Thirty-five context-mechanism-outcome configurations were developed across these domains. CONCLUSIONS The relative position of individual health care workers within the overall social network in hospitals is associated with influence and agency. As such, power to bring about change is inequitably and socially situated, and subject to specific contexts. The findings of this realist synthesis offer a lens through which to understand social ties in hospitals. The findings can help identify possible strategies for intervention to improve communication and distribution of power, for individual, team and wider multi-professional behavioural change in hospitals.
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Affiliation(s)
| | | | - Mike English
- Nuffield Department of Medicine, University of Oxford, UK
| | - Jacob McKnight
- Nuffield Department of Medicine, University of Oxford, UK
| | - Lisa Hinton
- The Healthcare Improvement Studies
Institute, University of Cambridge, UK
| | - Elinor Harriss
- Bodleian Health Care Libraries, University of Oxford, UK
| | - Geoff Wong
- Nuffield Department of Primary Care
Health Sciences, University of Oxford, UK
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16
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Renfrew MJ, Cheyne H, Burnett A, Crozier K, Downe S, Heazell A, Hundley V, Hunter B, King K, Marshall JE, McCourt C, McFadden A, Mondeh K, Nightingale P, Sandall J, Sinclair M, Way S, Page L, Gamble J. Responding to the Ockenden Review: Safe care for all needs evidence-based system change - and strengthened midwifery. Midwifery 2022; 112:103391. [DOI: 10.1016/j.midw.2022.103391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Improving teamwork in maternity services: a rapid review of interventions. Midwifery 2022; 108:103285. [DOI: 10.1016/j.midw.2022.103285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/04/2022] [Accepted: 02/09/2022] [Indexed: 11/22/2022]
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Ashmore AA, Kanga K, Kaur-Desai T, Thorman K, Archer N. Building leadership capabilities in maternity. BMJ LEADER 2021; 6:10-14. [DOI: 10.1136/leader-2021-000449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 11/14/2021] [Indexed: 11/03/2022]
Abstract
BackgroundOver recent years, there has been increasing recognition that effective leadership is critical to establishing positive organisational culture and improving patient outcomes. In maternity, there is a unique interplay between different specialties and disciplines in providing high-quality services.MethodsReview of literature pertaining to leadership and maternity.ResultsGood leadership is the key determinant in ensuring that our multi-professional teams function effectively. The relational aspects of teamworking, linked to safer delivery of services, have been explored in great detail in maternity services. However, there has been less focus on the application of leadership theory in this environment and the impact of interventions used in developing leadership skills within maternity teams.ConclusionsIn this paper, we discuss how leadership theory can be used to understand high profile maternity service failures and how effective team culture, clinical team building and individual leadership skill-development are strong contributors to this thinking. Specific examples are used to describe ongoing work in our drive for improvement and to highlight the current lack of evidence in this area.
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19
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Staying alive-training with anaesthetists. Best Pract Res Clin Obstet Gynaecol 2021; 80:55-66. [PMID: 34903435 DOI: 10.1016/j.bpobgyn.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/05/2021] [Indexed: 11/02/2022]
Abstract
An effective working relationship between obstetricians and anaesthetists is crucial for patient safety in maternity care. Anaesthetists' skills and scope of clinical practice complement those of obstetricians, particularly during obstetric emergencies. Anaesthetists also bring expertise in resuscitation, critical care, and a training programme that is underpinned by non-technical as well as technical skills. Through training together, obstetricians and anaesthetists can help plug one another's knowledge gaps, identify each other's blind spots, aid mutual decision-making, and share relevant national guidance between specialties. Training also aids the development of a shared mental model, which contributes to improved teamwork. To be effective, this training should involve the whole team, be conducted in-house, be used to tackle local as well as national priorities, and be repeated regularly.
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20
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O'Brien S, Attilakos G. A push for evidence: An effective training in operative birth. Best Pract Res Clin Obstet Gynaecol 2021; 80:49-54. [PMID: 34893437 DOI: 10.1016/j.bpobgyn.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 10/15/2021] [Indexed: 11/25/2022]
Abstract
Effective training in operative birth should be the only type of operative birth that trains the junior obstetricians who are exposed to it. Although it remains difficult to fully characterise, effective training in operative birth is likely to include (i) realistic, local, integrated simulation training and (ii) hands-on senior support for an extended period of time. To further improve skills training in operative birth, an evaluation of the real-world effectiveness of current training should take place, a core outcome set for clinical trials should be developed, and real-time reporting and tracking of practitioner-specific outcome measures should be implemented.
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Affiliation(s)
| | - George Attilakos
- Women's Health Division, University College London Hospitals NHS Foundation Trust, London, UK; Institute for Women's Health, University College London, London, UK
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21
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Negrini R, D'Albuquerque IMSC, de Cássia Sanchez E Oliveira R, Ferreira RDDS, De Stefani LFB, Podgaec S. Strategies to reduce the caesarean section rate in a private hospital and their impact. BMJ Open Qual 2021; 10:e001215. [PMID: 34385187 PMCID: PMC8362699 DOI: 10.1136/bmjoq-2020-001215] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 08/03/2021] [Indexed: 12/02/2022] Open
Abstract
There is a concern around the world of an increasing caesarean section rate. It was estimated that between 2010 and 2015, caesarean section rates increased by almost 50%. There are several implications for this, considering that caesarean sections are associated with higher costs and worse clinical outcomes. In this context, several interventions have been considered to increase vaginal delivery rates, including the Adequate Childbirth Project (PPA) in Brazil. This study aimed to verify the impact of the strategies adopted internally in the Hospital Israelita Albert Einstein (HIAE) located in São Paulo, Brazil, regarding the reduction of caesarean sections and their perinatal results. Actions to support our study were implemented in two phases based on the PPA schedule. These actions involved three axes: a multidisciplinary team, pregnant women and facility improvements. All pregnant women admitted for childbirth at the HIAE between 2014 and 2019 were included in this study. The overall rate of vaginal delivery in this study population and among primiparous women and the percentage of admissions to the neonatal intensive care unit (NICU) were analysed in three periods: before the implementation of PPA actions (period A), after the first phase of the project (period B) and after its second phase (period C). The results showed an increase in the average vaginal delivery rate from 23.57% in period A to 27.88% in period B, and to 30.06% in period C (AxB, p<0.001; BxC, p=0.004). There was a decrease in the average of NICU admissions over the periods (period A 19.22%, period B 18.71% and period C 13.22%); a significant reduction was observed when periods B and C (p<0.001) were compared.
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Affiliation(s)
- Romulo Negrini
- Departamento Materno Infantil, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | - Rita de Cássia Sanchez E Oliveira
- Departamento Materno Infantil, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
- Consultorio, TAGIDES - Unidade de Ultrassonografia, São Paulo, Brazil
| | | | | | - Sergio Podgaec
- Saúde da Mulher, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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Kelly S, Redmond P, King S, Oliver‐Williams C, Lamé G, Liberati E, Kuhn I, Winter C, Draycott T, Dixon‐Woods M, Burt J. Training in the use of intrapartum electronic fetal monitoring with cardiotocography: systematic review and meta‐analysis. BJOG 2021. [PMCID: PMC8359372 DOI: 10.1111/1471-0528.16619] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Sub‐optimal classification, interpretation and response to intrapartum electronic fetal monitoring using cardiotocography are known problems. Training is often recommended as a solution, but there is lack of clarity about the effects of training and which type of training works best. Objectives Systematic review of the effects of training healthcare professionals in intrapartum cardiotocography (PROSPERO protocol: CRD42017064525). Search strategy CENTRAL, Cochrane Library, MEDLINE, EMBASE, PsycINFO, British Nursing Database, CINAHL, ERIC, Scopus, Web of Science, ProQuest, grey literature and ongoing clinical trials were searched. Selection criteria Primary studies that reported impact of training healthcare professionals in intrapartum cardiotocography. Title/abstract, full‐text screening and quality assessment were conducted in duplicate. Data collection and analysis Data were synthesised both narratively and using meta‐analysis. Risk of bias and overall quality were assessed with the Mixed Methods Appraisal Tool and GRADE. Main results Sixty‐four studies were included. Overall, training and reporting were heterogeneous, the outcomes evaluated varied widely and study quality was low. Five randomised controlled trials reported that training improved knowledge of maternity professionals compared with no training, but evidence was of low quality. Evidence for the impact of cardiotocography training on neonatal and maternal outcomes was limited, showed inconsistent effects, and was of low overall quality. Evidence for the optimal content and method of delivery of training was very limited. Conclusions Given the scale of harm and litigation claims associated with electronic fetal monitoring, the evidence‐base for training requires improvement. It should address intervention design, evaluation of clinical outcomes and system‐wide contexts of sub‐optimal practice. Tweetable abstract Training in fetal monitoring: systematic review finds little evidence of impact on neonatal outcomes. Training in fetal monitoring: systematic review finds little evidence of impact on neonatal outcomes.
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Affiliation(s)
- S Kelly
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care University of Cambridge Cambridge UK
| | - P Redmond
- School of Population Health and Environmental Sciences King’s College London London UK
| | - S King
- Independent consultant Cambridge UK
| | - C Oliver‐Williams
- Cardiovascular Epidemiology Unit Department of Public Health and Primary Care University of Cambridge Cambridge UK
- Homerton CollegeUniversity of Cambridge Cambridge UK
| | - G Lamé
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care University of Cambridge Cambridge UK
| | - E Liberati
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care University of Cambridge Cambridge UK
| | - I Kuhn
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care University of Cambridge Cambridge UK
| | - C Winter
- PROMPT Maternity Foundation Southmead Hospital Bristol UK
| | - T Draycott
- Translational Health Sciences University of Bristol Bristol UK
| | - M Dixon‐Woods
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care University of Cambridge Cambridge UK
| | - J Burt
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care University of Cambridge Cambridge UK
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23
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White VanGompel E, Main EK. Safe care on maternity units: a multidimensional balancing act. BMJ Qual Saf 2021; 30:437-439. [PMID: 33452141 DOI: 10.1136/bmjqs-2020-012601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 01/19/2023]
Affiliation(s)
- Emily White VanGompel
- Departments of Family Medicine and Obstetrics and Gynecology, University of Chicago Pritzker School of Medicine, Evanston, IL, USA
| | - Elliott K Main
- Obstetrics and Gynecology / California Maternal Quality Care Collaborative, Stanford University School of Medicine, Palo Alto, CA, USA
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