Transforming Communication and Safety Culture in Intrapartum Care: A Multi‐Organization Blueprint

Abstract

Effective, patient-centered communication facilitates interception and correction of potentially harmful conditions and errors. All team members, including women, their families, physicians, midwives, nurses, and support staff, have a role in identifying the potential for harm during labor and birth. However, the results of collaborative research studies conducted by organizations that represent professionals who care for women during labor and birth indicate that health care providers may frequently witness, but may not always report, problems with safety or clinical performance. Some of these health care providers felt resigned to the continuation of such problems and fearful of retribution if they tried to address them. Speaking up to address safety and quality concerns is a dynamic social process. Every team member must feel empowered to speak up about concerns without fear of put-downs, retribution, or receiving poor-quality care. Patient safety requires mutual accountability: individuals, teams, health care facilities, and professional associations have a shared responsibility for creating and sustaining environments of mutual respect and engaging in highly reliable perinatal care. Defects in human factors, communication, and leadership have been the leading contributors to sentinel events in perinatal care for more than a decade. Organizational commitment and executive leadership are essential to creating an environment that proactively supports safety and quality. The problem is well-known; the time for action is now.

Common challenges managing bed and staff availability on labor and delivery units in the United States: A qualitative analysis

“…Finally, Tenure in role (y) 2 [1][2][3][4][5] Tenure in unit (y) 16 [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Nurse manager Tenure in role (y) 3 [2][3][4][5][6] Tenure in unit (y) 12 [8][9][10][11][12][13][14][15][16][17][18][19][20] we describe specific effective management practices for addressing each of the challenges we identified based on a framework of proactiveness and systematicness. After describing our study population, we present common management challenges among all the units we analyzed.…”

“…[22][23][24][25][26] Our analyses add to this body of work by describing how managers of labor and delivery units across the United States address issues of patient flow and nurse staffing. Prior studies of management have primarily focused on elements of safety culture related to communication and teamwork.…”

As a critical behavior to improve quality and patient safety in health care: speaking up!

“…Using structured techniques to communicate effectively (for instance: using SBAR, critical language) [45]. Having knowledge of human factors [46,47]. Studies have been showing that there is a continued need for communication, additional education, medication safety and prioritization in practice [19,37].…”

“…So that, providing training regarding to critical behaviors in regular intervals may improve speaking up behaviors of both medical students and residents of hospital. Ensuring 'Safety Culture' and 'Horizontal Communication' in a dynamic clinical setting [27,46,48]. Creating 'shared workmates norms' , 'common understanding of patient and patient's needs' and 'values about speaking up' may promote willingness to speak up in an organization [29,48,49].…”

“…3). The decision to speak up in a clinical setting is dynamic, highly context-dependent, embedded in the interaction rituals that suffuse everyday work and constrained by organizational dynamics in healthcare [27,46]. Voicing is affected by multiple things such as person, group, organization, human factors and leadership [46].…”