Authors, year and country Design



Key Findings

Data collection, sample and analysis

Patient safety/quality

Martijn et al. 2013 [33]

The Netherlands



1000 patient records Retrospective: content


Prospective incident reporting, type of incident, cause, actual harm, and probability of serious harm or death.

Expert postgraduate midwives reviewed safety incidents using the Prevention and Recovery Information System for Monitoring and Analysis method

Self-reported patient safety assessment instrument communication

problems; patient risk assessment based on obstetric history, health status, lifestyles factors, psychosocial problems, number of contacts during care, calls for help due to medical emergency, whether or not a safety incident had occurred and description of the safety incident and actions taken

Of the 1000 patient records involving contacts, 85 contained incidents, of which 25 were found to have had a significant

effect on the patient.

The majority of incidents found in the patients’ records concerned treatment and organizational factors

Sexton et al. 2006 [34]


Cross-sectional survey

N = 4700

Self-reported measurement of teamwork climate, perceptions of management, stress recognition and working conditions

Perceptions of the teamwork climate in the labour and delivery context are affected by the environment and the role within the team. For example, the caregivers need to feel supported and be enabled to report, ask question and speak up comfortably. Conflicts should be resolved and nurses and physicians should collaborate. Good teamwork was also associated with lower levels of caregiver burnout from their work. Finally, the teamwork climate related more to perceptions of adequate

staffing levels than to workload

Wagner et al. 2011 [35] USA

Cohort comparative (prospective) Intervention study: 1) Evidence-based protocols, 2) Formalized team training with emphasis on communication,

3) Standardization of electronic foetal monitoring with required documentation of competence, 4) A high-risk obstetrical emergency simulation programme, and

5) Dissemination of an integrated educational programme among all healthcare providers

Eleven adverse outcome measures

N = 217 - 1731

Self-reported instruments were used to measure the impact of the perinatal safety initiative (PSI) to evaluate and decrease adverse events and improve obstetric outcomes. A modified adverse outcome index (MAOI) was used in addition to patients’ perceptions of teamwork and commitment to patient safety. The questions were ‘Would you recommend the institution?” and “Did the staff work together?”. Finally, staff perceptions of safety were assessed by using questions from the Safety Culture Climate Survey

The MAOI decreased significantly to 0.8% from 2% (p < 0.0004), which was maintained throughout the two year of intervention period. Significant decreases over time were found for rates of return to the operating room and birth trauma was found. A significant improvement was found in staff perceptions of safety (p < 0.0001), in patient perceptions of whether staff worked together (p < 0.0001), in the management and in the documentation of abnormal foetal heart rate tracings, and the documentation of obstetric haemorrhage

Hoang & Quynh

2012 [36]


Mixed-method approach

Cross-sectional survey questionnaire (n = 210) and semi-structured interviews

(n = 22)

Self-reported instrument on preferences for different models of intrapartum care. Hospital (conventional) care, Midwifery-led care, and Planned homebirth.

Interviews included questions on views of travel time to safe delivery, safety, distance from hospital and delivery type

The women preferred to give birth in a hospital setting despite having to travel for two hours. Midwifery-led care with one hour travel time was the second most preferred model