Table 1

Features of safety identified in initial study of a single high-performing maternity unit (adapted from Liberati et al, 2019)18

Collective competenceThe unit displays a sense of interdependency. Collegial behaviours and strong social ties are visible among staff. Care is organised around the shared goal of safe childbirth. Professional boundaries are managed flexibly with deference to expertise rather than hierarchy.
Insistence on technical proficiencyVery high standards of proficiency in clinical tasks are expected. High-fidelity structured training is combined with informal learning through mentoring and legitimate peripheral participation.
Monitoring, coordination and distributed cognitionMechanisms are in place to maintain a shared awareness of the external situation in the maternity unit. Staff in coordinating roles play a control room function.
Clearly articulated and constantly reinforced standards of practice, behaviour and ethicsValues of ethical and safe behaviour are clear, articulated and reinforced through role modelling. Staff make positive use of social control mechanisms to ensure that other people behave in a way that is aligned with the unit’s standards.
Monitoring multiple sources of intelligence about the unit’s state of safetyMany forms of data are used to sense problems. Routine clinical data are scrutinised, updated and made available to all staff. Soft intelligence (such as patient feedback and staff ground knowledge) is used to learn and improve safety and nurtured through a widespread sense of psychological safety.
Highly intentional approach to safety and improvementCommitment to safety is collectively pursued and socially legitimised (not externally imposed). Combination of formal risk management (ie, allocated roles and formal activities) and embedded risk management (frontline clinicians preparing for risky situations and detecting small signs of deterioration).