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The measurement and improvement of maternity service performance through inspection and rating: An observational study of maternity services in acute hospitals in England.

ABSTRACT: OBJECTIVES:To determine whether the prior performance of maternity services, as measured by Royal College of Obstetricians and Gynaecologists performance indicators, is associated with ratings by the Care Quality Commission at subsequent inspection, and whether performance changes occur after inspection. METHODS:We used hospital activity data from 176 maternity sites inspected between October 2013 and March 2016 to generate a set of performance indicators developed by the Royal College of Obstetricians and Gynaecologists. We linked these data to Care Quality Commission data on inspection dates and rating scores and used regression models, controlling for site level effects, to estimate the relationships between inspection ratings and performance indicators before and after inspections. RESULTS:Coefficients measuring the relationship between indicator performance and subsequent inspection rating score had wide confidence intervals which crossed zero suggesting no statistically significant relationship prior to inspection. The same absence of statistical significance was observed for changes in indicator performance after inspection. CONCLUSIONS:The use of routine data for performance monitoring is becoming increasingly important as regular inspection is costly and regulators require accurate and timely intelligence. However, we found no statistically significant relationships between inspection ratings and performance indicators before or after inspections in maternity services. This calls into question the validity and reliability of the performance indicators, the inspection process and ratings, or both, as measures of performance.

SUBMITTER: Allen T

PROVIDER: S-EPMC7584108 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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The measurement and improvement of maternity service performance through inspection and rating: An observational study of maternity services in acute hospitals in England.

Allen Thomas T Walshe Kieran K Proudlove Nathan N Sutton Matt M

Health policy (Amsterdam, Netherlands) 20200826 11

<h4>Objectives</h4>To determine whether the prior performance of maternity services, as measured by Royal College of Obstetricians and Gynaecologists performance indicators, is associated with ratings by the Care Quality Commission at subsequent inspection, and whether performance changes occur after inspection.<h4>Methods</h4>We used hospital activity data from 176 maternity sites inspected between October 2013 and March 2016 to generate a set of performance indicators developed by the Royal Co ...[more]

PMID: 32919795

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Project description:Minoritised ethnic perinatal women can experience judgemental and stigmatising care due to systemic racism. Discriminatory care contributes to increased risks of poor maternal and infant outcomes, including higher rates of mental ill-health. This study aimed to explore minoritised ethnic women's experiences of maternity services, including maternity care and mental health support, within a North-West England locality. Here we use an equity lens to report the findings that describe if and how women's personal, cultural, and spiritual needs were met, their experiences of discriminatory and prejudicial care, and to identify recommendations for service provision. A mixed-methods study was undertaken comprising an online survey, interviews, and community consultations. Questions explored access to and experiences of antenatal care and education; information, communication, and choice; experiences of (dis)respect and judgement; mental health needs and support; cultural/religious needs and support; and overall experiences of maternity care. Eligibility criteria were: women, 18+ years, from self-reported minoritised ethnic backgrounds, who had given birth in the previous 2 years and received maternity care in the locality. Surveys were available in seven languages and distributed via social media, mother-baby groups, and community locations. English-speaking survey participants were invited to take part in a follow-up interview. Community staff were approached to collect data on behalf of the study team. Quantitative data were analysed descriptively (n, %) and merged with qualitative data into descriptive themes. Overall, 104 women provided data; most self-identified as Asian (65.0%) or Black (10.7%) and were aged between 30-34 (32.0%) or 25-29 years (23.3%). Four descriptive themes are reported: 'accessing care' details variations and barriers in accessing maternity care; 'communication needs, and resources' describes views on adaptions and resources for specific communication needs; 'meeting religious and cultural needs' outlines how various religious and cultural needs were met by maternity providers; 'discriminatory or stigmatising care' reports on experiences of pejorative and inequitable care. An equity lens helped identify areas of discriminatory and inequitable care. Key recommendations include cultural safety training for staff; service-user engagement and co-production of research and resources, and appropriate facilities and recording systems to facilitate individualised, needs-based maternity care.

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Dataset Information

The measurement and improvement of maternity service performance through inspection and rating: An observational study of maternity services in acute hospitals in England.

Publications

The measurement and improvement of maternity service performance through inspection and rating: An observational study of maternity services in acute hospitals in England.

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