Methodology
Our methodology sets out the stages of our review of maternity services across Scotland.
Our approach, as described here is a working methodology, which we may update in the light of input from our advisory groups, or newly emerging evidence.
The review will follow a broad cycle based on established service enquiry and improvement processes. These steps are not intended to be linear as there will be overlaps and feedback loops:
Step 1: Plan and set-up (September)
- Develop review methodology
- Plan and invite membership of the advisory groups
- Set dates and locations for advisory group meetings
- Plan schedule and participants for roundtables (quarterly) and in-person workshops (final months)
- Introductory meetings with key stakeholders
- Plan communication/engagement strategy
- Initial discussions with key stakeholders
- Set up review webpage and mailbox
- Plan for trauma-informed approach to interviews and engagement.
Step 2: Convene advisory groups and advance methodologies/plans (October)
- Initial meetings of each advisory group
- Firm up schedule for site visits
- Initial plan for data requests
- Revisions to methodology as appropriate following advisory group meetings.
Step 3: Evidence gathering (October to April)
Routine and statistical data – identify needs, submit requests, analyse
To include as a minimum::
- Healthcare Improvement Scotland reports and action plans
- National and regional data on interventions and outcomes + international benchmarking
- Maternity surveys (patients, senior and frontline staff versions) Insights analysis and report
- Service configuration, staffing and workload data.
Site visits (up to one full week): to involve
- Meetings with Maternity Voices and local user groups and relevant organisations
- Interviews/focus groups with maternity staff at different levels
- Interviews with individual women, birthing people and families
- Listening sessions in community settings regularly used by parents (e.g. village halls, church, mosque, gurdwara, synagogue, children’s centres) to discuss their experiences and priorities.
The approach to the site visits is based on a rapid appraisal approach where a small team spends intensive time in a setting. Data gathering includes document, observations, meeting attendance, individual and/or focus group interviews.
Sites selection is expected to include around half of all health boards. Selection will be based on maximum variation of settings in terms of geography, local population characteristics and service configurations.
Selection will not be based on any assumptions about site performance or quality. It is not anticipated that the final report will present service-based case studies, as the aim is to draw out general lessons informed by detailed understanding of context, including geographical challenges.
Examples of good practice will be sought in addition to understanding of problems and these may be presented as case studies to illustrate and provide examples of where positive care can be sustained or scaled up.
Briefer, less intensive visits or engagement will be conducted within all remaining health boards.
International visits or case studies
We may also arrange visits or online meetings to describe key features of maternity systems with optimal intervention and outcome rates, comparable populations and geography and midwifery care (for example, Denmark, Sweden or Norway).
Rapid evidence reviews
Rapid evidence reviews may be conducted by members of the review team, with support from advisory group members where appropriate, and using an established template and process (Gavine et al. 2018) depending on unfolding questions. We will not conduct reviews where comparable reviews have already been completed in recent years.
One review is anticipated at this stage, to look at evidence on service configurations for remote and rural areas and in relation to distributed or centralised services.
Step 4: Engagement and participation
- Continue advisory group meetings
- Round tables with wider group of organisations (community & advocacy, professionals)
- Listening events within site visits (see site visits)
- Individual interviews with women & families who have experienced harm or loss
- Meetings with key stakeholders and professional organisations
- Extend engagement where required in addition to that in site visits and above plans
- Maintain updated summary information on website about process and activities.
Step 5: Analysis, synthesis, report and recommendations
- Review team works on analysis of all data gathered including site visit and statistical data, interviews and meeting notes, background and service documents
- Integrate findings of rapid evidence reviews if conducted
- Write up good practice case studies
- Workshops with advisory groups to share and discuss emerging findings and then report plan/draft
- Draft report, revise, submit.
To contact the review team please email ScotlandMaternityReview@citystgeorges.ac.uk.