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  • Quality and reporting of large-scale improvement programmes: a review of maternity initiatives in the English NHS, 2010–2023

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Original research
Quality and reporting of large-scale improvement programmes: a review of maternity initiatives in the English NHS, 2010–2023
  1. James McGowan1,
  2. Bothaina Attal1,
  3. Isla Kuhn1,2,
  4. Lisa Hinton3,
  5. Tim Draycott4,
  6. Graham P Martin1,
  7. Mary Dixon-Woods1
  1. 1 The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
  2. 2 School of Clinical Medicine, University of Cambridge, Cambridge, UK
  3. 3 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  4. 4 Department of Women's Health, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
  1. Correspondence to Professor Mary Dixon-Woods; md753{at}medschl.cam.ac.uk

Abstract

Background Large-scale improvement programmes are a frequent response to quality and safety problems in health systems globally, but have mixed impact. The extent to which they meet criteria for programme quality, particularly in relation to transparency of reporting and evaluation, is unclear.

Aim To identify large-scale improvement programmes focused on intrapartum care implemented in English National Health Service maternity services in the period 2010–2023, and to conduct a structured quality assessment.

Methods We drew on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidance to inform the design and reporting of our study. We identified relevant programmes using multiple search strategies of grey literature, research databases and other sources. Programmes that met a prespecified definition of improvement programme, that focused on intrapartum care and that had a retrievable evaluation report were subject to structured assessment using selected features of programme quality.

Results We identified 1434 records via databases and other sources. 14 major initiatives in English maternity services could not be quality assessed due to lack of a retrievable evaluation report. Quality assessment of the 15 improvement programmes meeting our criteria for assessment found highly variable quality and reporting. Programme specification was variable and mostly low quality. Only eight reported the evidence base for their interventions. Description of implementation support was poor and none reported customisation for challenged services. None reported reduction of inequalities as an explicit goal. Only seven made use of explicit patient and public involvement practices, and only six explicitly used published theories/models/frameworks to guide implementation. Programmes varied in their reporting of the planning, scope and design of evaluation, with weak designs evident.

Conclusions Poor transparency of reporting and weak or absent evaluation undermine large-scale improvement programmes by limiting learning and accountability. This review indicates important targets for improving quality in large-scale programmes.

  • health services research
  • healthcare quality improvement
  • health policy
  • obstetrics and gynecology
  • womens health

Data availability statement

Data are available upon reasonable request. Please contact the first author.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjqs-2023-016606

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    Data availability statement

    Data are available upon reasonable request. Please contact the first author.

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    Footnotes

    • X @jgmcgowan, @ilk21, @LisaHinton4, @graham_p_martin, @MaryDixonWoods

    • Contributors MD-W is the guarantor of the study. Conceptualisation: JM, MD-W. Data curation: JM, BA. Formal analysis: JM, BA. Funding acquisition: JM, MD-W. Investigation: JM, BA, IK. Methodology: JM, BA, IK, LH, TD, GPM, MD-W. Project administration: JM, IK. Resources: JM, IK, MD-W. Software: JM, IK. Supervision: GPM, MD-W. Validation: LH, TD, GPM, MD-W. Visualisation: JM. Writing—original draft: JM, MDW. Writing—review and editing: all authors.

    • Funding The Health Foundation's grant to THIS Institute.

    • Competing interests TJD: Research and Innovation lead for PROMPT Maternity Foundation and has a part-time appointment at NHS Resolution where he leads on a Safety Action within the Maternity Incentive Scheme.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.