Stress, anxiety, and the erosion of trust: Maternity staffs’ experiences of incident management

Elsevier, AJOG Global Reports, in press, 2022, article 100084.
Victor Olagundoye, Monica Quinlan, Robin Burrow

Adverse incidents in maternity care and other healthcare systems continues to be a major cause of morbidity and mortality with significant financial cost to healthcare organisations, patients, and their families. Over the last decades healthcare organisations have focused their attention on improving the quality of patient care, safety, and experience. However, very little attention has been given to understanding and improving staff experience. This is despite the high probability that healthcare professionals who experience their workplace positively will deliver higher quality care, report incidents more commonly, and actively engage in incident investigation and learning processes.  The purpose of the study is to explore maternity staffs’ experiences of the incident reporting and investigation process, with specific reference to its impact on trust in local risk management leadership and organizational process. Semi-structured in-depth qualitative interviews analyzed using a methodological procedure that reveals the human experience of complex social phenomena (Interpretive Phenomenological Analysis).  Tertiary university maternity teaching hospital in England (UK) with approximately 6000 deliveries per annum. A purposive sample of 10 staff (2 consultants, 3 specialist registrars and 5 midwives) all involved in incidents requiring formal investigation during the preceding 12 months. The lived experiences, personal feelings, and perceptions of how the incident reporting and investigation process impacts on their trust in the risk management leadership and organizational process. Incident reporting and investigation were found to be perceived by staff as very stressful events with no structured feedback and support system in place for staff. We found that this lead to diminished trust in the risk management leadership and organizational process with staff relying on colleagues for support and validation of their practice. The study showed that poorly managed processes of incident reporting and investigation result in diminished trust in risk management leadership and organizational processes. It also reinforces understanding that adverse incidents have a profound impact on the mental health and wellbeing of healthcare professionals. Factors that will likely mitigate these experiences and effects include: (1) timely updates and feedback from incident investigation; (2) high levels of leadership visibility; and (3) structured support for staff during and after incident reporting and investigations.