NEDs for Safety: examining the Non-Executive Director (NED) Maternity & Neonatal Safety Champion role

Background

Patient safety in maternity and neonatal care delivered by NHS Trusts has been under sustained scrutiny, given numerous high-profile scandals and investigations. A frequent finding is that poor safety cultures within healthcare organisations may mean that staff do not feel able to speak up about their concerns, that systems and processes for monitoring safety are not functioning effectively, and that learning from incidents and adverse events is suboptimal.

A key recommendation has been that Trust boards need to be better sighted on the performance and governance of maternity and neonatal services within their organisations.

Within this context, the Non-Executive Director (NED) Maternity & Neonatal Safety Champion (MNSC) role has been developed as a designated NED champion role to support the delivery of change in relation to maternity and neonatal safety. It is one of five NED champion roles recommended by NHS England. However, like the broader NED role, it remains understudied.

Aims of the study:

• To explore how the NED MNSC role is envisaged in policy, how the contribution of NED MNSCs is imagined, and how they are made responsible for safety.
• To examine how NED MNSCs understand, enact, and experience their role.
• To understand how NED MNSCs perceive the value, usefulness, and effectiveness of their role, and how it may be strengthened in the future.

Methods

The study used documentary analysis to explore how the NED MNSC role is envisaged in national policy. This was accompanied by semi-structured interviews with 20 NED MNSCs to examine how they understand, enact and experience their role. Participants were recruited from across England and represented a range of clinical and non-clinical backgrounds. All interviews were audio-recorded, transcribed, and analysed using thematic analysis.

Key findings

Documentary analysis revealed a strong policy characterisation of NED MNSCs as positive agents for change, positioned to provide independent, supportive challenge to maternity services and to prompt board-level scrutiny of the quality and safety of maternity provision. Although participants recognised the importance of this role, interviews highlighted significant tensions between national policy expectations and the practical realities of enacting the role.

Participants described a clear mismatch between the extensive responsibilities and high level of accountability set out in national guidance and the resources, clarity, and organisational support available to discharge the role effectively. A major concern related to the lack of clarity regarding the scope of the role and limited consideration of the time required to undertake its responsibilities. As a consequence, participants reported substantial variation in sense-making, with the role interpreted and enacted differently across Trusts.

In the absence of clear guidance, many NED MNSCs described relying heavily on their personal and professional resources (such as their own judgement, prior knowledge, experience, and expertise) to interpret the role and manage its demands. Participants also observed that their diverse backgrounds, combined with variation in local Trust cultures, meant that not all NED MNSCs were equally supported or positioned to deliver the role effectively.

Team

Natalie Armstrong, Aaron Horsey, Nicola Mackintosh, Graham Martin, Maria Zubair

Funding

This study/project is funded by the National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration (GM PSRC). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care