Complex intervention to improve empathy within maternity services: a mixed methods feasibility study with pilot evaluation.

Lack of empathy in National Health Service maternity services contributes to adverse outcomes for women, babies and practitioners. While empathy training can improve individual communication, sustainable improvement in empathy requires system-level change. We conducted a mixed-methods feasibility study with pilot implementation and evaluation of an initiative to improve system-level empathy within a maternity unit. The initiative was a complex intervention that included empathy training for practitioners, training in empathic teamwork and a system-level empathy workshop. The mixed-methods evaluation was conducted in two phases. Phase 1 included questionnaires assessing participant satisfaction and intention to change behaviour. Phase 2 included questionnaires assessing perceived change in empathy, staff satisfaction and patient satisfaction. System-level changes generated by healthcare leaders were also recorded. Quantitative data were summarised using descriptive statistics and free text comments were analysed using thematic analysis informed by the Consolidated Framework for Implementation Research. Of the 177 maternity services staff who took part, 123 completed the first evaluation phase. 89% of these rated their satisfaction with the workshops as 8 or higher and 86% rated the likelihood that the training would improve empathy as 8 or higher on 10-point scales. Thematic analysis of free-text comments generated four themes: (1) appreciation for intraprofessional and interprofessional interaction, (2) value of creating a supportive environment, (3) enhanced ability to identify practical approaches to empathy and (4) desire for additional workshops. Twenty-one participants completed the second evaluation phase. Most (76%) agreed that the work had led to greater empathy. System-level changes included the introduction of free coffee for staff, weekly 'gratitude pledges' and a fortnightly community newsletter. This mixed-methods feasibility study demonstrated that implementation of the intervention is feasible and acceptable and generated pilot data to inform future evaluation. Early data suggest positive trends in empathy and patient satisfaction, supporting the need for sustained implementation and longitudinal evaluation.