Rational, aim, and objectives: A positive patient safety culture in maternity units is linked to higher quality of care and better outcomes for mothers. However, safety culture varies across maternity units. Analyses of variation in safety culture using statistical process control (SPC) methods may help provider units to learn from each other's performance. This study aims to measure patient safety culture across maternity units in Oman using SPC methods. Methods: The 36-item Safety Attitude Questionnaire (SAQ) was distributed to all doctors, nurses, and midwifes working in ten maternity care units in Oman's hospitals and analysed using SPC methods. The SAQ considers six domains: job satisfaction, perception of management, safety climate, stress recognition, teamwork, and work condition. Results: Of the 892 targeted participants, 735 (82%) questionnaires were returned. The overall percentage of positive safety responses in all hospitals ranged from 53% to 66%, but no hospital had the targeted response of above 75%. Job satisfaction had the highest safety score (4.10) while stress recognition was the lowest (3.17). SPC charts showed that the overall percentage of positive responses in three maternity units (H1, H7, and H10) was above and one (H4) was below the control limits that represent special cause variation that merits further investigation. Conclusion: Generally, the safety culture in maternity units in Oman is below target and suggests that considerable work is required to enhance safety culture. Several maternity units showed evidence of high/low special cause variation that may offer a useful starting point for understanding and enhancing safety culture.

Purpose The purpose of this paper is to summarize studies that have examined patient safety culture in maternity units and describe the different purposes, study designs and tools reported in these studies while highlighting gaps in the literature. Design/methodology/approach Peer-reviewed studies, published in English during 1961–2016 across eight electronic databases, were subjected to a narrative literature review. Findings Among 100 articles considered, 28 met the inclusion criteria. The main purposes for studying PSC were: assessing intervention effects on PSC (n=17), and assessing PSC level (n=7). Patient safety culture was mostly assessed quantitatively using validated questionnaires (n=23). The Safety Attitude Questionnaire was the most commonly used questionnaire (n=17). Interventions varied from a single action lasting five weeks to a more comprehensive four year package. The time between baseline and follow-up assessment varied from 6 to 24 months. No study reported measurement or intervention costs, and none incorporated the patient’s voice in assessing PSC. Practical implications Assessing PSC in maternity units is feasible using validated questionnaires. Interventions to enhance PSC have not been rigorously evaluated. Future studies should report PSC measurement costs, adopt more rigorous evaluation designs and find ways to incorporate the patient’s voice. Originality/value This review summarized studies examining PSC in a highly important area and highlighted main limitations that future studies should consider.

This is the first study to investigate the association between the nationality of nurses and their perceptions of safety culture in maternity care units in Ministry of Health hospitals in Oman. The results of this study will inform policy-makers, hospital administrators, researchers and nurse managers on designing and

PURPOSE: To review Arabic surveys used to measure maternal satisfaction. METHODOLOGY: Peer-reviewed studies published in English and Arabic since 2000 were reviewed across eight databases. Surveys were assessed by: survey construction, reliability, and validity. FINDINGS: The seven studies that met the inclusion criteria were in English and included seven different Arabic surveys. Survey items ranged from eight to 32 and were translated from English (3/7) or were originally written in Arabic (4/7). Six surveys were pilot tested. Dimensions covered by the surveys varied but all measured satisfaction about providers’ interpersonal care. Internal reliability was reported for four surveys and none reported the test-re-test results. Three studies reported content validity, one reported face validity, one reported construct validity, and none reported criterion validity. Participants’ inclusion criteria varied but all studies excluded women with still births or obstetric complications. When surveyed within hospital (3/7), participants were approached within 72 hours after delivery while those surveyed outside the hospital were approached two weeks, seven weeks, or two months after discharge. Overall, the eight-item survey was found short, well tested with good psychometric properties. CONCLUSIONS: The psychometric properties of Arabic surveys were determined in limited settings, were not well reported, and varied. The eight-item survey is a well-tested survey with good psychometric properties. Furthermore, rigorous evaluation of Arabic surveys in different contexts with wider inclusion criteria is required. Our findings will promote further research in this area and will help enhance maternal experience with childbearing.

Background: Measuring maternal satisfaction in Arab countries is an essential indicator of care quality. However, existing surveys have limited psychometric properties and inclusion criteria. Aims: To present the psychometric properties of the Arabic Childbirth Care Satisfaction Survey (CCSS). Methods: The Arabic CCSS was developed from 2 English surveys. In 2017, 13 mothers assessed survey items in terms of clarity, importance and acceptability. The CCSS was distributed to all mothers who delivered a live baby during the 4-week study period in 9 hospitals in Oman. A sample of 461 participants was used for principal component analysis (PCA) and another sample of 408 participants (after removing missing data) was used for confirmatory factor analysis (CFA). Two-sample independent t tests were conducted to establish discriminant validity. Stata software was used for the analysis. Results: The survey demonstrated good face and content validity with all items rated above 3 out of 5. Out of the 3566 targeted population, 958 (26.9%) mothers participated. PCA identified 2 factors labelled as communication and control (Cronbach’s a = 0.90) and care organization (Cronbach’s a = 0.68) with good internal reliability. CFA demonstrated good model fit, confirming construct validity. Mothers who had vaginal delivery were more satisfied (P < 0.05) compared with those who underwent caesarean section, thus establishing good discriminant validity. Conclusion: A short Arabic CCSS tool was developed. This new 10-item tool had good face and content validity, good internal reliability, construct validity and discriminant validity. It can provide valuable information to clinicians and decision-makers about the quality of maternity services.