SCALING: Learning how to replicate and scale a successful maternity safety improvement programme

Timescale: May 2017-June 2019

Funder: The Health Foundation

Key points

  • Maternity units vary in terms of performance on safety indicators and outcomes, but it is not clear how to replicate the conditions that make a maternity unit safer
  • Based on analysis of conditions in a high performing maternity unit, we aim to identify the mechanisms underlying safety, and then assess the extent to which these are evident in other units
  • We will use this learning to develop a training package for improvement in maternity units


Following on from the successful project Why is Southmead safe? Developing a programme theory of 'PROMPT' (PRactical Obstetric Multi-Professional Training), the SCALING project aims to develop a model for the successful replication and scaling of improvement interventions, using the Southmead Maternity Unit (Bristol, UK) as a case study. While Southmead has developed the PROMPT training package, implementing and replicating the safe environment of Southmead has not been straightforward: following uptake of the PROMPT programme, some units have shown substantial improvement, while others have demonstrated more limited progress.

The research study

Using ethnographic observations and semi-structured interviews, the SCALING project will produce a comprehensive account of the mechanisms underlying the safety outcomes observed in the Southmead Maternity Unit. The project will then use similar methods to evaluate the extent to which these mechanisms are present in a sample of UK maternity units that have attempted to implement the PROMPT programme, with different levels of success. Finally, the project will develop a prototype training package, to be known provisionally as the LM-SIP (Learning-based Maternity Safety Improvement Programme), that will include the original PROMPT training as well as recommendations on what needs to be in place for the programme to work. This will be tested and refined in a sample of UK maternity units to the point where it is ready for deployment in a controlled trial.

Research team

Prof Mary Dixon-Woods (PI, University of Cambridge), Prof Tim Draycott (Co-I, Southmead Hospital), Dr Carolyn Tarrant (Co-I, University of Leicester), Dr Elisa Liberti (University of Cambridge), Dr Alexis Paton (University of Leicester), Dr Janet Willars (University of Leicester).

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