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An exploration of the effects of clinical negligence litigation on the practice of midwives in England: A phenomenological study.
Midwifery. 2016 Feb; 33:55-63.M

Abstract

OBJECTIVE

to explore how midwives׳ personal involvement in clinical negligence litigation affects their midwifery practice.

DESIGN

descriptive phenomenological study using semi-structured interviews.

SETTING

in 2006-2007 in-depth interviews were conducted in participants׳ homes or at their place of work and focused on participants׳ experience of litigation. Participants were recruited from various regions of England.

PARTICIPANTS

22 National Health Service (NHS) midwives who had been alleged negligent.

FINDINGS

clinical practice affected was an increase in documentation, fear of practising outside clinical guidelines and electronic fetal monitoring of women at low obstetric risk; these changes were not widespread. Changes in practice were sometimes perceived negatively and sometimes positively. Forming a good relationship with childbearing women was judged to promote effective midwifery care but litigation had affected the ability of a minority of midwives to advocate for women if this relationship had not been established. Litigation could result in loss of confidence leading to self-doubt, isolation, increased readiness to seek medical assistance and avoidance of working in the labour ward, perceived as an area with a high risk of litigation. A blame culture in the NHS was perceived by several midwives. In contrast an open non-punitive culture resulted in midwives readily reporting mistakes to risk managers. Litigation lowered midwifery morale and damaged professional reputations, particularly when reported in the newspapers. Some midwives expressed thoughts of leaving midwifery or taking time off work because of litigation but only one was actively seeking other employment, another took sick leave and one had left midwifery and returned to nursing.

KEY CONCLUSIONS

litigation can have a negative effect on midwives׳ clinical practice and morale and fosters a culture of blame within the NHS.

IMPLICATIONS FOR PRACTICE

education regarding appropriate documentation, use or non-use of electronic fetal monitoring and the legal status of clinical guidelines will enable midwives to respond proportionately to the threat of litigation. A culture of openness and sharing the problem when adverse events occur would help to extinguish the current blame culture in the National Health Service. Litigation must be recognised by management as capable of inducing loss of confidence and reluctance to work in the labour ward. Promoting teamwork will help support these midwives. The potential for litigation in maternity care could affect retention of the midwifery workforce.

Authors+Show Affiliations

University of Manchester, UK. Electronic address: j.robertson11@btinternet.com.University of Manchester, UK. Electronic address: ann.thomson@manchester.ac.uk.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26527326

Citation

Robertson, Judith H., and Ann M. Thomson. "An Exploration of the Effects of Clinical Negligence Litigation On the Practice of Midwives in England: a Phenomenological Study." Midwifery, vol. 33, 2016, pp. 55-63.
Robertson JH, Thomson AM. An exploration of the effects of clinical negligence litigation on the practice of midwives in England: A phenomenological study. Midwifery. 2016;33:55-63.
Robertson, J. H., & Thomson, A. M. (2016). An exploration of the effects of clinical negligence litigation on the practice of midwives in England: A phenomenological study. Midwifery, 33, 55-63. https://doi.org/10.1016/j.midw.2015.10.005
Robertson JH, Thomson AM. An Exploration of the Effects of Clinical Negligence Litigation On the Practice of Midwives in England: a Phenomenological Study. Midwifery. 2016;33:55-63. PubMed PMID: 26527326.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An exploration of the effects of clinical negligence litigation on the practice of midwives in England: A phenomenological study. AU - Robertson,Judith H, AU - Thomson,Ann M, Y1 - 2015/10/16/ PY - 2015/05/29/received PY - 2015/09/02/revised PY - 2015/10/12/accepted PY - 2015/11/4/entrez PY - 2015/11/4/pubmed PY - 2017/2/10/medline KW - Adverse event KW - Blame culture KW - Clinical practice KW - Litigation KW - Midwives KW - Phenomenology SP - 55 EP - 63 JF - Midwifery JO - Midwifery VL - 33 N2 - OBJECTIVE: to explore how midwives׳ personal involvement in clinical negligence litigation affects their midwifery practice. DESIGN: descriptive phenomenological study using semi-structured interviews. SETTING: in 2006-2007 in-depth interviews were conducted in participants׳ homes or at their place of work and focused on participants׳ experience of litigation. Participants were recruited from various regions of England. PARTICIPANTS: 22 National Health Service (NHS) midwives who had been alleged negligent. FINDINGS: clinical practice affected was an increase in documentation, fear of practising outside clinical guidelines and electronic fetal monitoring of women at low obstetric risk; these changes were not widespread. Changes in practice were sometimes perceived negatively and sometimes positively. Forming a good relationship with childbearing women was judged to promote effective midwifery care but litigation had affected the ability of a minority of midwives to advocate for women if this relationship had not been established. Litigation could result in loss of confidence leading to self-doubt, isolation, increased readiness to seek medical assistance and avoidance of working in the labour ward, perceived as an area with a high risk of litigation. A blame culture in the NHS was perceived by several midwives. In contrast an open non-punitive culture resulted in midwives readily reporting mistakes to risk managers. Litigation lowered midwifery morale and damaged professional reputations, particularly when reported in the newspapers. Some midwives expressed thoughts of leaving midwifery or taking time off work because of litigation but only one was actively seeking other employment, another took sick leave and one had left midwifery and returned to nursing. KEY CONCLUSIONS: litigation can have a negative effect on midwives׳ clinical practice and morale and fosters a culture of blame within the NHS. IMPLICATIONS FOR PRACTICE: education regarding appropriate documentation, use or non-use of electronic fetal monitoring and the legal status of clinical guidelines will enable midwives to respond proportionately to the threat of litigation. A culture of openness and sharing the problem when adverse events occur would help to extinguish the current blame culture in the National Health Service. Litigation must be recognised by management as capable of inducing loss of confidence and reluctance to work in the labour ward. Promoting teamwork will help support these midwives. The potential for litigation in maternity care could affect retention of the midwifery workforce. SN - 1532-3099 UR - https://www.unboundmedicine.com/medline/citation/26527326/An_exploration_of_the_effects_of_clinical_negligence_litigation_on_the_practice_of_midwives_in_England:_A_phenomenological_study_ DB - PRIME DP - Unbound Medicine ER -