Stress, anxiety, and erosion of trust: maternity staff experiences with incident management

Abstract

Adverse incidents in maternity care and other healthcare systems continue to be a major cause of morbidity and mortality, with significant financial costs to healthcare organizations, patients, and their families. Over the last decades, healthcare organizations 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. This study aimed to explore maternity staff's experiences with the incident reporting and investigation process, with specific reference to its impact on trust in local risk management leadership and the organizational process. Semistructured in-depth qualitative interviews were analyzed using a methodological procedure for understanding human experiences of complex social phenomena (interpretive phenomenological analysis). The study was conducted in a tertiary university maternity teaching hospital in England with approximately 6000 deliveries per annum. A purposive sample of 10 staff members (2 consultants, 3 specialist registrars, and 5 midwives) was selected, with all participants having been involved in incidents requiring formal investigation during the preceding 12 months. The main outcome measures were the lived experiences, emotions, and perceptions regarding how the incident reporting and investigation process affected their trust in risk management leadership and the organizational process. Incident reporting and investigation were found to be perceived by staff members as very stressful events with no structured feedback and support system for staff. We found that this led to diminished trust in risk management leadership and the 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 reinforced the understanding that adverse incidents have a profound impact on the mental health and well-being of healthcare professionals. Factors that could 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.