Article Text

Download PDFPDF
Using data and quality monitoring to enhance maternity outcomes: a qualitative study of risk managers’ perspectives
  1. Rebecca A Simms1,2,
  2. Andrew Yelland3,
  3. Helen Ping1,
  4. Antonia J Beringer3,
  5. Timothy J Draycott1,2,4,
  6. Robert Fox5
  1. 1Department of Women's Health, North Bristol NHS Trust, Bristol, UK
  2. 2School of Clinical Sciences, University of Bristol, Bristol, UK
  3. 3Faculty of Health and Life Sciences, University of the West of England, Bristol, UK
  4. 4The Health Foundation, London, UK
  5. 5Department of Women's Health, Taunton & Somerset NHS Foundation Trust, Taunton, UK
  1. Correspondence to Dr R A Simms, The Chilterns, Department of Women's Health, Southmead Hospital, North Bristol NHS Trust, Westbury on Trym, Bristol BS10 5NB, UK; becky.simms{at}


Introduction Risk management is a core part of healthcare practice, especially within maternity services, where litigation and societal costs are high. There has been little investigation into the experiences and opinions of those staff directly involved in risk management: lead obstetricians and specialist risk midwives, who are ideally placed to identify how current implementation of risk management strategies can be improved.

Methods A qualitative study of consultant-led maternity units in an English region. Semistructured interviews were conducted with the obstetric and midwifery risk management leads for each unit. We explored their approach to risk management, particularly their opinions regarding quality monitoring and related barriers/issues. Interviews were recorded, transcribed and thematically analysed.

Results Twenty-seven staff from 12/15 maternity units participated. Key issues identified included: concern for the accuracy and validity of their local data, potential difficulties related to data collation, the negative impact of external interference by national regulatory bodies on local clinical priorities, the influence of the local culture of the maternity unit on levels of engagement in the risk management process, and scepticism about the value of benchmarking of maternity units without adjustment for population characteristics.

Conclusions Local maternity risk managers may provide valuable, clinically relevant insights into current issues in clinical data monitoring. Improvements should focus on the accuracy and ease of data collation with a need for an agreed maternity indicators set, populated from validated databases, and not reliant on data collection systems that distract clinicians from patient activity and quality improvement. It is clear that working relationships between risk managers, their own clinical teams and external national bodies require improvement and alignment. Further discussion regarding benchmarking between maternity units is required prior to implementation. These findings are likely to be relevant to other clinical specialties.

  • Healthcare quality improvement
  • Risk management
  • Patient safety
  • Performance measures
  • Safety culture

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.