Barriers and Facilitators of Safe Communication in Obstetrics: Results from Qualitative Interviews with Physicians, Midwives and Nurses

Abstract

Patient safety is an important objective in health care. Preventable adverse events (pAEs) as the counterpart to patient safety are harmful incidents that fell behind health care standards and have led to temporary or permanent harm or death. As safe communication and mutual understanding are of crucial importance for providing a high quality of care under everyday conditions, we aimed to identify barriers and facilitators that impact safe communication in obstetrics from the subjective perspective of health care workers. A qualitative study with 20 semi-structured interviews at two university hospitals in Germany was conducted to explore everyday perceptions from a subjective perspective (subjective theories). Physicians, midwives, and nurses in a wide span of professional experience and positions were enrolled. We identified a structural area of conflict at the professional interface between midwives and physicians. Mandatory interprofessional meetings, acceptance of subjective mistakes, mutual understanding, and debriefings of conflict situations are reported to improve collaboration. Additionally, emergency trainings, trainings in precise communication, and handovers are proposed to reduce risks for pAEs. Furthermore, the participants reported time-constraints and understaffing as a huge burden that hinders safe communication. Concluding, safety culture and organizational management are closely entwined and strategies should address various levels of which communication trainings are promising.

Birthing under the Condition of the COVID-19 Pandemic in Germany: Interviews with Mothers, Partners, and Obstetric Health Care Workers

“…However, if this is not the case, in line with international studies, a concern remains about the restrictions: They may affect 'the rights of birthing women on safe motherhood during the COVID-19 pandemic' or fear of a 'fallback to alienation during intervention-focused hospital deliveries' if partners are excluded from some part of the process [48,49]. Thus, alternative ways of working when facing the COVID-19 pandemic require awareness but also skills such as speaking up and shared decision making [50].…”

“…Managing a pandemic is further exacerbated by existing weaknesses in the obstetrics departments which have become more obvious over the course of the pandemic. This mainly refers to staff shortages, frequent staff turnover, burdening administrative tasks for the study hospitals, and the acute lack of space and other environmental restraints [50]. These circumstances increase the stress of the mothers giving birth, as the absence of partners or other familiar persons may not be compensated for by HCW or digital communication.…”

Psychological Intervention to Improve Communication and Patient Safety in Obstetrics: Examination of the Health Action Process Approach

“…Subgroup analyses of participants with shorter work experience showed improvements in coping planning from baseline to post-intervention, while those with more than 5 years of work experience did not. As presented in similar research, encouragement in speaking-up as was trained, is highly appreciated by HWC in younger professional age (Schmiedhofer et al, 2021). In contrast, HCW with longer work experience perceived fewer patient safety risks and higher work satisfaction after the intervention, but also reported lower coping planning.…”

Preventable Adverse Events in Obstetrics—Systemic Assessment of Their Incidence and Linked Risk Factors

“…Among other things, the studies presented refer to inadequate communication as a cause of pAEs [ 26 ]. In addition, negative communication can increase the negative effects of inadequate staffing, thus leading to more risk factors such as diagnostic or medication errors due to stress levels, overwhelmed staff, inefficiency due to no or poor hand-offs or staff who is entirely unavailable.…”