| Title: | SCALING – Learning how to replicate and scale a successful maternity safety improvement programme |
| Project Description: | Initially promising healthcare improvement interventions often prove difficult to replicate and scale: what works in one setting may not be as effective, and may even be harmful, when implemented elsewhere. Excessive attention to specific quality improvement (QI) interventions in a narrow sense (e.g. checklists) risks overlooking enabling infrastructures that may be needed to secure authentic improvement. These technological, environmental, social, and cultural conditions are often relegated to the category of “context,” but are vital to the success of improvement efforts. An important task is therefore to develop a conceptual and empirical understanding of the interactions between contexts and interventions.
This study aims to develop a model for the successful replication and scaling of improvement interventions, using the Southmead Maternity Unit (Bristol, UK) as a case study. Developing and adopting an evidence-based multi-professional training package (PROMPT: PRactical Obstetric Multi-Professional Training), the Southmead Maternity Unit has reported sustained improvements in perinatal outcomes, as well as improved knowledge, clinical skills, and teamwork. However, propagating these successes beyond the context of origin, has not been straightforward; some units have shown substantial improvement, while others have demonstrated more limited progress. Using ethnographic observations and semi-structured interviews, we will produce a comprehensive account of the mechanisms underlying the safety outcomes observed in the Southmead Maternity Unit, including features both of its context and of specific interventions such as the PROMPT training programme. We will then use similar methods to evaluate the extent to which these mechanisms are present in a sample of UK maternity units that have attempted to implement PROMPT with variable outcomes. Finally, we will develop a prototype training package that will be delivered alongside the PROMPT intervention, to be known as the LM-SIP (Learning-based Maternity Safety Improvement Programme). This will be tested and refined in a sample of UK maternity units to the point where it is ready for deployment in a controlled trial. |
| Funder: | Health Foundation |
| Project organisation | |
| Start date: | 1st March 2017 |
| End date: | 1st March 2019 |
| Contact person: | Dr Elisa Liberati |
| Contact Details: | Telephone: 01223 330322 E-mail: egl24@medschl.cam.ac.uk |
| Further Information, References and Publications | |