Background It has become apparent that significant numbers of women suffer harm during episodes of care. The rising cost to both service users and providers has led to an increase in activity around the management of patient safety. This has included strategies for incident reporting. However these have had variable success in improving safety and there is a need to understand in more detail specific barriers to reporting in maternity care.
Method The study used an ethnographic approach. The data collection tools were participant observation, semi-structured interviews and scrutiny of documents related to patient safety management. Interviews were conducted with 32 staff. These included midwives, obstetricians, managers and Health Care Assistants. Observations were undertaken at meetings, including Risk Management Meetings and also in clinical areas. Framework analysis was used to identify themes and categories.
Results Reporting was not an individual activity. There existed a process of reporting that made use of collegial work groups to validate concerns. A contested definition of adverse events was dichotomised by philosophies of risk in pregnancy and birth. However, these cut across professional groups. There was evidence of a lively, if largely invisible, workplace subculture which was sometimes characterised by resistance and conflict and whose aims did not always coincide with those of the organisation.
Conclusion Issues of collegiality, conflict and resistance within the subculture influenced incident reporting and could thwart organisational patient safety objectives. These results suggest that bureaucratic organisational risk management strategies may enjoy limited success while they ignore the cultural and subcultural aspects of organisational life.
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