THIS Institute

1. Commitment to safety and improvement at all levels, with everyone involved

Descriptions and examples:

  • The unit shows an authentic commitment to learning from risky situations and adverse events, and it uses this learning to drive improvements.

  • Staff are skilled in noticing hazards and seek to address them in real-time. When appropriate, hazards are reported so that the whole unit can learn.

  • Staff invest in making the unit better. They are always looking for ways to improve working processes and the care environment – often through small-scale, easily actionable ideas – and are praised for their efforts.

  • Individuals in management roles are visible and accessible. They listen carefully to frontline staff and families, seeking to respond promptly to concerns or suggestions reported to them.

  • The unit has a range of formal risk management systems, processes, and roles (including audits and/or a risk management team) that are known, trusted and used by staff in the unit.

2. Technical competence, supported by formal training and informal learning

Descriptions and examples:

  • Individuals are expected to perform their clinical tasks to a high standard of proficiency.

  • The unit invests in keeping staff trained and up to date. Regular high quality training sessions are mandatory for all members of staff, and the unit management ensures that everyone has allocated time to attend.

  • Training is usually multidisciplinary and includes structured teaching, skill drills, and simulations.

  • People also learn in less formal ways, for example through mentorship, observing colleagues at work, and discussing and reflecting on clinical cases.

  • Senior members of staff make sure that more junior staff have opportunities to debrief and ask questions after experiencing complex clinical situations, and that they learn from theirs and others’ experience.

  • A social space is accessible to all staff (a communal coffee room, for example) to support informal knowledge-sharing, real-time information updates, and reflection.

  • The many different forms of learning allow staff to demonstrate competence, confidence, and coordination in high-stress, risky situations, and help to create trust among team members.

3. Teamwork, cooperation, and positive working relationships

Descriptions and examples:

  • Teamwork is central to all of the activities carried out in the unit. Care, training, and research are conducted with the input of all professions and disciplines.

  • People in different roles respect each other and value everyone’s contributions to achieving the goals of the unit and upholding its values.

  • Through working and training together, people are aware of each other’s roles, skills, and competencies (who does what, how, why and when) and can work effectively together, thus demonstrating “collective competence”.

  • When deciding who should perform a certain task, the team regard skills and experience as more important than seniority or professional roles: the person with the right skills for the specific task will intervene.

  • When disagreements happen between professions or roles (for example on treatment decisions), they are settled calmly, through open, thoughtful discussion, and through reference to shared goals. People do not resort to hierarchies, displays of power, or aggressive behaviour.

  • People look after each other. Relationships are good, and any disruptive or bullying behaviours are recognised and managed effectively.

  • Staff wellbeing and morale are recognised as important contributors to safety.

4. Constant reinforcing of safe, ethical, and respectful behaviours

Descriptions and examples:

  • The goals and values of the unit are clear: achieving good birth outcomes and promoting the dignity and wellbeing of parents and families. There is a shared expectation that members of staff will behave consistently with these goals and values.

  • Expected standards of practice are reinforced through the behaviours of everyone in the unit, including all professions and individuals at all levels – from the most junior to the most senior.

  • Newcomers are supported to understand and adhere to the unit’s high standards, but are also encouraged to make suggestions for improvement based on previous experience.

  • People intervene if the goals and values of the unit are not upheld. They do so mostly in informal ways (for example by using humour or having a ‘private word’), but are ready to intervene more formally when needed (for example through reporting systems and escalating).

  • Unsafe or inappropriate behaviours are noticed and corrected in real time, so they don’t become normalised.

  • Although the highest standards of practice are expected, it is recognised that errors will sometimes happen.

  • Errors are recognised both as problems and as opportunities for learning. People are encouraged to discuss them openly, and actions are taken to reduce risk of their recurrence.

5. Multiple problem-sensing systems, used as basis of action

Descriptions and examples:

  • The unit uses multiple methods to “sense” and anticipate problems and identify opportunities for improvement, including staff and families’ voice, hard data, and clinical simulation.

  • These multiple forms of intelligence are also used to identify good practices and celebrate them where appropriate.

  • Families are encouraged to share their experience, in real time and retrospectively, through formal and informal feedback systems. This feedback is seen as key for improving care.

  • Members of staff feel that they can speak up for safety. They are confident that their concerns will be heard and that action will be taken as a result, whenever possible.

  • This sense of psychological safety cultivated on the unit makes it possible to learn from everyday events.

  • Clinically relevant data are collected and constantly monitored using visual methods (a clinical dashboard, for example) to identify concerning trends and guide improvement efforts.

  • Members of staff are reminded about the importance of looking at and interrogating data.

6. Systems and processes designed for safety, and regularly reviewed and optimised

Descriptions and examples:

  • Working processes and information technology are well designed, and kept functional and up to date.

  • The unit’s equipment and the physical environment are designed consistent with human factors and ergonomics principles to be safe, appropriate, and easy to use.

  • People constantly review and seek to optimise working processes (eg operating theatre scheduling) and tools (eg post-partum haemorrhage kits) to meet the requirements of excellent care provision.

  • Simulation is used to observe how systems and processes operate in realistic conditions and to test the usability and appropriateness of equipment and other resources needed for care.

  • Once good practice is identified, it is standardised and spread across the unit, to avoid unwarranted variation.

7. Effective coordination and ability to mobilise quickly

Descriptions and examples:

  • Well-functioning systems (eg IT systems, whiteboards) are in place to capture and share up-to-date information regarding each woman.

  • These systems help to identify risks early and to initiate an effective response.

  • Structured handovers and regular safety huddles, ward rounds, and board rounds enable a shared, helicopter-level understanding of the state of the unit as a whole, in real time.

  • Identified individuals in the team have specific responsibility and expertise for patient flow and management between the different care settings.

  • Mandatory training emphasises the importance of situational awareness, which includes enabling staff to recognise the important elements of their environment that may affect patient care.

  • Simulation-based training and structured emergency protocols allow staff to be competent and confident in responding to crises.