8 features of safe maternity units

A strong commitment to safety and improvement is found at all levels and in all roles. It is clear in the behaviours of all.

Safety is understood in a broad and inclusive way, incorporating the importance of listening to women, choice, care and kindness.

Commitment is matched by action, including action to address inequalities.

All staff feel a shared sense of ownership and responsibility for safety and improvement within the unit.

Staff work proactively with service users and with colleagues across the maternity service pathway to keep mothers and babies safe.

Those using services feel confident that there is a shared commitment to safety and improvement.

Staff have strong technical skills, including the clinical skills of the different professional groups involved in care.

As well as strong technical competencies, staff have strong “non-technical” skills, such as those relating to teamwork and communication.

Standards of practice are evidence-based.

The expectations of practice are clear and well understood by all staff.

Staff recognise diverse health needs, for example relating to people’s backgrounds and ethnicity, and can address them effectively.

Standards of practice and technical and non-technical skills are consistently reinforced through high quality training, with protected time available for participation, with backfill provided as needed.

An ethos of learning is everywhere, with newcomers socialised into expectations of safe behaviour and practice.

Multiple opportunities are available to learn, with colleagues explaining not just “how” but also “why” and allowing each other to develop their skills through reflective practice.

Team members have clearly defined roles and responsibilities.

Leadership is effective and inclusive. It ensures the voice of maternity service users is heard and that they are recognised as members of the team.

Appropriate use is made of tools, techniques, and systems to support communication, coordination, and situation awareness.

Clear protocols and systems are in place for handling obstetric emergencies, including clear lines of responsibility and well-understood approaches to coordinated responses.

Training emphasises teamwork and uses evidence-based techniques such as simulation.

Speaking up is strongly encouraged – colleagues and maternity service users all feel comfortable in speaking about concerns or making suggestions.

Those using services, including women and birth partners, feel part of the team and that they too can contribute to safety and improvement.

A positive vision and commitment to inclusive, respectful and ethical behaviours is constantly articulated and backed by well-founded procedures and action.

Efforts are made to reduce situational triggers to stress, conflict and tension where possible.

Professional boundaries and differences of opinion are managed effectively to reduce conflict while demonstrating respect for differing views.

Communication is respectful, honest, two-way and inclusive. It is devoid of racist language and discriminatory attitudes or behaviours towards anyone.

Those who use services and, where appropriate, their birth partners are recognised as partners in high-quality care.

The preferences and choices, including religious and cultural preferences, of those who use services are respected, and where possible incorporated into care. Staff have time to understand and enact these preferences.

Transgressive behaviour (including disrespect and discrimination) is noticed and dealt with effectively, with support from high-quality management and HR (human resources) systems to address problems promptly, fairly and with determination.

Anti-racist policies and anti-racist practices are understood and embraced by all staff along the maternity care pathway.

Colleagues routinely demonstrate that they value one another’s contributions, for example through noticing what they do and expressing appreciation.

Colleagues can raise concerns with, and challenge, one another in a respectful way.

Those using services feel comfortable and confident that they will be cared for respectfully and inclusively, that they can raise concerns if needed, and that concerns will be addressed.

Expectations of good practice in relation to communication that is inclusive and respectful of diversity are clear, shared by all, and supported by high quality training and role modelling.

Information is two-way, with professional information (clinical knowledge about options available and the evidence on their benefits, harms, and uncertainties, along with professionals’ experience of different options) and personal information (including life circumstances, values, and preferences) all considered. Staff have time to understand and enact these preferences.

Staff provide evidence-based information clearly and impartially, listen closely to the questions, preferences and decisions communicated by maternity service users, and respond to them in a clear and impartial way.

To support informed decision-making, people using maternity care are given clear information about their care, which is communicated in plain language without jargon and in culturally appropriate ways and supported by interpretation services where needed.

People using care are encouraged to ask questions and given as much time as feasible to consider their options so they can make choices and give informed consent.

People using maternity care are asked about any concerns in a manner that conveys a sincere desire to hear from them. Clear information about how to raise concerns is available.

Cultural awareness training for staff encourages awareness of their own biases and the impacts on care.

“Problem-sensing” behaviours are strongly encouraged, with the full range of techniques for discovering issues, concerns, and risks deployed.

Multiple approaches are used to identify potential risks to safety and concerns of staff or services users about the service.

Data and analyses are made available to frontline staff to help them improve their practice.

Clinical data, including socio-demographic characteristics such as ethnicity, are routinely recorded, analysed and used improve the quality of services.

Colleagues are alert and sensitive to “soft” signs of problems that may be difficult to articulate or quantify. This involves listening to those at the frontline of care and using a range of techniques to diagnose risks.

Maternity service users and their birth partners, are encouraged to share ideas and concerns, with appropriate attention to diverse preferences and abilities.

Systems, processes and procedures for staff and maternity service users to raise concerns, offer suggestions, make complaints or provide other forms of feedback are clear, well publicised, understood by all, and consistently applied.

There are clear processes, with associated responsibilities and timelines, for acknowledging, acting on and responding to concerns, complaints, and feedback.

All colleagues, including but not only those in senior positions, cultivate ‘psychological safety’ – the “belief that one will not be punished or humiliated for speaking up with ideas, questions, concerns or mistakes”.

When there are problems, there is transparency about what has gone wrong and what is being done to address it.

Organisations and the wider healthcare systems need to respond to and learn from incidents when they happen, ensuring that maternity service users and families affected by a patient safety incident have their voices listened to, their questions addressed and their needs met.

The working environment, including processes, systems and structures, is purposefully designed and optimised to help people to perform at their best.

The approach taken emphasises the importance of human factors/ergonomics, which is based on the principle that system and human performance can be improved through an integrated and systematic approach to individual skills, teamwork, equipment, task, environment, and organisational design.

Equipment, space, information and procedures are all optimised to reduce the cognitive demands on staff (allowing them to focus on the things that really matter in delivering safe care), reduce physical demand, and enhance safety.

Improvements are developed in partnership with staff and maternity service users, using co-design methods where possible and appropriate.

System design accounts for diversity, including (but not only) the needs of minoritised groups and those who are socio-economically deprived.

Standards, processes and systems are continually reviewed and adapted as technology and circumstances change and new information or evidence emerges.

Appropriate methods, including simulation, are used to test the usability and impact of new systems or improvements of existing ones.

The importance of high-quality leadership and management as a defining feature of a safety culture is recognised and is clearly visible in practice.

Leaders and managers are role models, embodying the behaviour they expect of others, listening attentively and appreciatively to the suggestions of their colleagues and of service users, acting on suggestions when it is appropriate, and explaining their reasons when it is not.

Leaders and managers set a clear, ambitious, and meaningful vision which inspires people by focusing on the things that matter to service users and staff and aligns efforts around that goal.

Leaders and managers are champions for maternity services in wider organisations and systems, ensuring that safety is prioritised across pathways and seeking to ensure that maternity services receive the resources they need.

Management systems and practices are sound and effective, underpinned by high quality risk management systems and HR (human resource) management systems.

Leaders and managers engage in a meaningful way with marginalised and minoritised groups, including socially disadvantaged and ethnic minority communities, to improve the quality, safety and inclusiveness of services for these groups.

Leaders and managers foster psychological safety among all staff and maternity users, so people feel safe to speak up when needed.