Midwives’ Experiences With a Handover Checklist: A Grounded Theory Study

Abstract

BackgroundQuality of care and patient safety is highly recognised and a priority within health services globally. Healthcare services in Norway are among the best in the world. Nevertheless, there is still a need for quality improvement and evaluation of the services. In healthcare, checklists have proven to reduce unwanted variation by standardising processes, which in turn contribute to increased quality in care. However, a poorly handled handover situation may be a potential threat to patient safety. To improve the quality of care, a checklist was implemented at a large maternity clinic in Norway. In the present study we explored midwives’ experiences with the use of a checklist implemented to improve the quality of the handover of mother and baby between wards and hospital shifts from birth until mother and baby are discharged from the hospital. MethodWe conducted a grounded theory (GT) study, performing one focus group interview and 13 individual interviews, including altogether 16 midwives. Years of experience as a midwife ranged from 1 to 30 years. The interviews were recorded, transcribed and analysed using open, selective and theoretical coding. ResultsThe main concern faced by the midwives was distilled down to no common understanding of the purpose of the checklist nor consensus on how to use the checklist. The generated grounded theory, individual interpretation of the checklist, involved the following three strategies that all seemed to explain how the midwives solved their main concern: following the system, evaluating the system and distancing themselves from the system. The only condition that seemed to influence a change in the use of the checklist was if a midwife experienced an adverse outcome in mother or baby, which could be related to the use of the checklist.ConclusionThe findings in this study indicate that a general lack of common understanding and consensus on the rationale for implementing a checklist resulted in an individual use of the checklist and was therefore a potential hazard to patient safety. This individual use of the checklist might have resulted in an attitude towards the checklist more as an individual tool and less as a quality improvement initiative. Findings also emphasise the importance of a clear implementation strategy supervised by the management. Further research should explore the understanding of organisational and cultural context when implementing a checklist to clinical practice.