Communication, wellbeing and adverse events in healthcare: How can we support maternity healthcare professionals disclosing news to patients that an adverse event has occurred?

Adverse events within any area of healthcare are inevitable as humans are fallible (Robertson & Long, 2018), and maternity services within the UK are no exception. Within the past few years, maternity care within the UK has been in the spotlight due to high profile failings in care. Evidence from the NHS litigation authority suggests that maternity claims represent the third-highest number of clinical negligence claims. The increasing number of negligence claims is of a great burden to the NHS. Maternity is a high-risk environment, and adverse events occur and will continue to occur. However, an important element in managing the consequences of an adverse event is the disclosure to the patient involved and/or their family. Despite this, as few as 30% of adverse events may currently be disclosed to patients (Birks et al., 2014).

This thesis aimed to investigate how healthcare professionals within UK maternity services can be supported to communicate the news to patients that an adverse event has occurred through a series of studies. Study 1 systematically reviewed the literature on the views and experiences of patients and healthcare professionals on adverse event disclosure. The findings of this review suggested that although healthcare professionals advocated disclosure, several barriers prevented healthcare professionals from conducting effective disclosure. Potential ways to facilitate disclosure in order to meet patients' needs for disclosure include clarity regarding the legal aspects of disclosure, modelling appropriate disclosure practices, an open and transparent culture and providing training on adverse event disclosure.
Study 2 explored the views and experiences of UK maternity healthcare professionals on adverse event disclosure through the use of a qualitative interview study. The findings of this study illuminated the need to provide clarity on the Duty of Candour regulation within the UK, a need for transparency surrounding the emotional consequences of adverse events and disclosure, a need for training specific to adverse event disclosure, and difficulties drawing the line between adverse events and complications within the speciality of maternity.

Using the MRC guidelines for complex interventions, (MRC, 2008), a training intervention to enhance maternity healthcare professionals skills with the disclosure of adverse events was developed. Study 3 involved delivering the training intervention to maternity healthcare professionals and assessing the acceptability and feasibility of the intervention. Preliminary investigations suggest that this was perceived as acceptable by maternity healthcare professionals and was perceived as being useful. The training workshop had the potential to improve knowledge of adverse event disclosure and improve healthcare professional's confidence in conducting disclosure.

In combination, the findings of this PhD suggest that one of the potential ways to support maternity healthcare professionals with the disclosure process is by providing adverse event disclosure training.