Improving the quality and safety of maternity services is an international top agenda item. This
thesis describes the progress towards the development of a multidimensional approach to measure
the quality and safety of care in ten maternity units in Oman based on three of the five
dimensional Patient Safety Measurement and Monitoring Framework (PSMMF) which include
measuring "past harm" and "anticipation and preparedness”.
The three monitoring approaches used in this research are: (1) measuring the patient safety culture
(2) measuring patient satisfaction (3) and monitoring caesarean section rates.
The specific objectives of the research are to (1) measure patient safety culture level, (2) examine
the association between nurse’s nationality and patient safety culture, (3) validate an Arabic
language survey to measure maternal satisfaction about the childbearing experience, (4) measure
patient satisfaction about the childbearing experience, and (5) to examine caesarean section rates
across maternity units using statistical process control charts.
This thesis started with four systematic reviews that focused on (1) the use of patient safety culture
for monitoring maternity units (2) the available interventions to improve patient safety culture (3)
Arabic surveys available for measuring maternal satisfaction and (4) the use of statistical process
control charts for monitoring performance indicators. The overall conclusion from these reviews that these approaches are being increasingly used in maternity, found feasible and useful, and
there are areas that need attention for future work. Five field studies were conducted to address the
research aim and objectives.
Patient safety culture was measured by a cross-sectional survey of all staff in the ten maternity
units. It was found that safety culture in Oman is below the target level and that there is wide
variation in the safety scores across hospitals and across different categories of staff.
Non-Omani nurses have a more positive perception of patient safety culture than Omani nurses in
all domains except in respect of stress recognition and this difference need further investigation
and needs to be considered by designers of interventions to enhance patient safety culture.
Using two existing validated English surveys, an Arabic survey was developed, validated, and
used to measure maternal satisfaction with childbirth services. It was found that the new survey
has good psychometric properties and that in all the ten hospitals, mothers were satisfied with the
care provided during child delivery but satisfaction score varied across hospitals and groups of
participants.
Caesarean section rate in the last 17 years was examined using statistical process control charts to
understand the variation across the ten hospitals. It was found that caesarean section rate is above
the rate recommended by the World Health Organisation. Special cause variations were detected
that warrant further investigation.
In conclusion, the field studies demonstrated that it is feasible to use the three approaches to
monitor quality and safety in maternity units. However, further work is required to use these data
to enhance the quality and safety of care. Additionally, future work is needed to cover the other
three dimensions of the PSMMF. / Ministry of Health in Oman,
| Identifer | oai:union.ndltd.org:BRADFORD/oai:bradscholars.brad.ac.uk:10454/18500 |
| Date | January 2019 |
| Creators | Al Nadabi, Waleed K.A. |
| Contributors | Mohammed, Mohammed A., Faisal, Muhammad |
| Publisher | University of Bradford, Faculty of Health Studies |
| Source Sets | Bradford Scholars |
| Language | English |
| Detected Language | English |
| Type | Thesis, doctoral, PhD |
| Rights | <a rel="license" href="http://creativecommons.org/licenses/by-nc-nd/3.0/"><img alt="Creative Commons License" style="border-width:0" src="http://i.creativecommons.org/l/by-nc-nd/3.0/88x31.png" /></a><br />The University of Bradford theses are licenced under a <a rel="license" href="http://creativecommons.org/licenses/by-nc-nd/3.0/">Creative Commons Licence</a>. |
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