Tools for establishing a sustainable safety culture within maternity services. A retrospective case study.

Objective: This article reports the findings from a single case study on the long-term sustainability of a quality system in a large maternity unit. Method: The empirical basis is an analysis of documents related to the development, implementation, maintenance and outcome of the system over two decades. The main elements of the quality system are reported as findings, and the possible effects of the different elements are presented and discussed based on theories on safety management and leadership. Result: The findings suggest that the quality system served as the basis for a meaningful workplace community. The structure of meetings, research, training and budget input were all central factors for the development of the system. It resulted in systematic ongoing improvement, participation from all levels of the organization and trust within the organization. The effects of the system may still be seen after the end point of this study. Conclusions: It remains the responsibility of the management to ensure an adequate professional standard of services by a continuous internal quality assurance system for enhanced patient safety.