Important new research, funded by the National Institute for Health Research (NIHR), to help plug the evidence gap regarding the impact of maternity staffing and skill mix on the safety, quality and cost of maternity care in the UK was published in Health Services and Delivery Research (
The results of the Sandall et al study made for some interesting reading, with outcomes largely determined by the women’s assessed level of clinical risk, parity and age. The effects of the size and status of the Trust were found to be small, although ‘Larger trust size reduced the chance of a healthy mother outcome and also reduced the likelihood of a healthy mother/healthy baby dyad outcome, and increased the chances of other childbirth interventions’.
Although staffing levels alone did not necessarily affect outcomes and the study’s chosen experience measures, when considered with parity and women’s risk, the number and type of staff did make a difference: ‘Increasing the number of doctors had the greatest impact on outcomes in higher-risk women and increasing the number of midwives had the greatest impact on outcomes in lower-risk women. Although increased numbers of support workers impacted on reducing childbirth interventions in lower-risk women, they also had a negative impact on the healthy mother/healthy baby dyad outcomes in all women. In terms of maximising the capacity of a trust to deliver babies, midwives and support workers were found to be substitutes for each other, as were consultants and other doctors. However, any substitution between staff groups could impact on the quality of care given. Economically speaking, midwives are best used in combination with consultants and other doctors’.
One of the most important messages for managers to take from this study is the importance of employing appropriate staff for each particular setting and that there are ‘limited opportunities for role substitution’.
Sandall J, Murrells T, Dodwell M (2014). The efficient use of the maternity workforce and the implications for safety and quality in maternity care: a population-based, cross-sectional study. Health Services and Delivery Research 2(38).