Understanding staff views and experiences of a clinical practice change to reduce stillbirth in South Asian born women: A cross-sectional survey

Abstract Background: To capture the views and experiences of clinical staff following the implementation of a new clinical guideline aimed at reducing stillbirth at term in South Asian women, to identify barriers to implementation. Methods: Cross sectional survey of clinical staff providing maternity care, including midwives, obstetricians and shared-care general practitioner at a Victorian metropolitan university-affiliated teaching hospital caring for about 10,000 women per year at three separate hospital sites. Staff were asked to provide their agreement with ten statements assessing: perceived need for the guideline, implementation processes, guideline clarity, and clinical application. Two open-ended questions provided opportunities to express concerns and offer suggestions for improvement. Results: 120 staff completed the survey, the majority (n=89, 74%) of which were midwives. The majority of staff thought the guideline was clear with respect to the rationale (n=95, 79%,), the criteria for whom they applied (83%, n=99), and the procedures and instructions within the guideline were clear (74%, n=89). However, staff reported an increase in workload following the implementation of the guideline (72%, n=86) and expressed concerns related to rationale and evaluation of the guidelines, lack of education for staff and women, increased workload and insufficient resources, and patient safety and access to care. Challenges relating to shared decision making and communicating with women whose first language is not English were also identified. Conclusion: This assessment of staff views and experiences of a new clinical practice guideline has identified key barriers to and opportunities for improving implementation. It has also highlighted additional challenges relating to new clinical guidelines which focus on culturally and linguistically diverse (CALD) women.