Staff Experience of Implementing a Safety Bundle for Operative Vaginal Birth: A Mixed Methods Study
Sasha M. Skinner, Arunaz Kumar, Eleanor Kippen, Daniel L. Rolnik, Peter Neil, Nadine Murry, Alison Dale, Shai Bynon, Ben W. Mol, Ryan J. HodgesABSTRACT
Introduction
We implemented a safety bundle for operative vaginal birth, including routine intrapartum ultrasound to assess fetal position, a structured team time‐out and procedural checklist, a birth experience survey and postnatal debrief pathway. This study assesses maternity staff experience of implementing this bundle.
Materials and Methods
This mixed‐methods study involved four maternity hospitals in Australia. Surveys sent to maternity staff sought feedback on the bundle for 12‐months following implementation using Likert‐style and free‐text questions. Likert‐style responses were compared in the first and second 6 months, as well as between obstetric and midwifery, and senior and junior clinical roles. Results from quantitative and qualitative analysis of survey data guided further in‐depth qualitative enquiry using semi‐structured interviews in a sequential convergent design.
Results
There were 117 survey responses from obstetric ( n = 27) and midwifery ( n = 90) staff, including senior ( n = 55) and junior ( n = 62) roles. In the second 6 months, staff more often reported using the bundle “Always” or “Most of the time” (90% vs. 69%, p = 0.003), that the bundle improved accuracy of clinical assessment (85% vs. 69%, p = 0.018), communication with the woman (79% vs. 44%, p = 0.002), woman's birth experience (73% vs. 42%, p = 0.003), and 93% reported improved safety. Responses were similar between obstetric and midwifery staff, and junior and senior staff. Qualitative analysis identified improved safety culture with five underlying themes summarized by the acronym CALMER: clarity and transparency, agency and empowerment, learning and agility, mutuality and engagement, resourcing and feasibility.
Conclusions
Maternity staff perceived significant improvement in safety culture with the implementation of an operative vaginal birth safety bundle.