Understanding the Implementation of Obstetric Emergency Training

Abstract

Obstetric emergency training programmes, such as PROMPT (Practical Obstetric Multi-Professional Training) can effectively improve outcomes for both mothers and babies. Understanding how best to implement training in new settings is less well understood. This thesis describes the challenges and facilitators to implementation, in a parallel process evaluation of a nationwide PROMPT roll-out across Scottish maternity units. The study aims were to determine why PROMPT may be more successfully implemented in some units compared to others, and to assess the associations between staff safety attitudes and training implementation.

Four Scottish maternity units were purposively selected to participate in a mixed-methods study combining both qualitative (focus groups, interviews and training observations) and quantitative (staff safety attitude questionnaires) approaches. A thematic analysis of the qualitative data was performed, using Normalization Process Theory (NPT) as a theoretical framework. Questionnaire data were statistically analysed using quantile regression.

The findings showed that the facilitators for implementation include receptivity to change, perception of PROMPT as both valuable and coherent, the presence of champions and teamwork, and managerial support for training; these facilitators reflect the NPT core constructs of coherence, cognitive participation, collective action and reflexive monitoring. The core inhibitors to implementation include difficulties attending training, over-reliance on goodwill and perceived risks of participation.

Maternity staff safety attitudes were more positive in smaller units. These units were also identified as able to implement PROMPT earlier than larger units. Training therefore may be easier to establish in smaller hospitals, or where more positive safety attitudes already exist. Findings also suggest that PROMPT may modify attitudes over time, towards a more positive outlook.

This research has informed the further development of PROMPT, identifying that some units may benefit from social franchising initiatives, such as an implementation support team, to establish local training.

Date of Award	25 Jan 2022
Original language	English
Awarding Institution	University of Bristol
Supervisor	Andrew J Moore (Supervisor) & Tim Draycott (Supervisor)