City Research Online

Abstract

Background
Spread and scale-up of evidence-based interventions in healthcare is complex, given the challenges of different contexts, networks of interactions and collaborative processes in healthcare delivery. Quality Improvement Collaboratives (QICs) provide a multi-organisational structured approach to improvement. However, the current evidence base underpinning QICs effectiveness is still limited and effectiveness appears strongly bound to context. Seeing scale-up and spread as a social practice, this paper explores the work of Patient Safety Collaboratives (PSC) in England that support implementation of a nationally mandated perinatal optimisation care bundle.

Methods
The PremPath study explored implementation of perinatal optimisation at scale across different regions within England. We report from the first work package, comprising scoping interviews with 40 strategic leads from across Patient Safety Collaboratives (PSCs) in England who support implementation and quality improvement of perinatal optimisation. Analysis drew on the constant comparison method and Normalisation Process Theory (NPT) to explore implementation activities and contextual challenges.

Results
Findings demonstrate cognitive participation as a key feature of the improvement work undertaken at regional level. This entailed bringing healthcare staff together into a multi-disciplinary community of practice focused on the pathway. Data work underpinned efforts to identify priorities for improvement and track progress. However, fluctuations in performance contrasted with the ideal of continuous improvement. Regional leaders identified turbulence in the context of maternity and neonatal care as contributory factors to fluctuations. Our work highlights, for regional leads, the hidden emotional work and micropolitics of engaging clinical staff in communities of practice and shifts attention from individual implementation efforts to the broader context of maternity and neonatal care, which presented as dynamic, unstable and already crowded with other improvement priorities.

Conclusions
Our findings provide an overview of the landscape of perinatal optimisation at regional level in England, helping to open up the ‘black box’ of collaborative efforts managed via national PSCs. Our work highlights the significance of the micropolitical dimensions of regional leads’ improvement work, and raises questions around how best to ensure sustainability of change given the current inelasticity of the implementation environment of maternity and neonatal care.

Publication Type:	Article
Additional Information:	© The Author(s) 2026. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Publisher Keywords:	Quality improvement, Optimisation, Normalisation process theory, Health innovation networks, Maternity care, Neonatal care, Qualitative research, Communities of practice, Cognitive participation
Subjects:	R Medicine > R Medicine (General) R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Departments:	School of Health & Medical Sciences
SWORD Depositor:	Symplectic Administrator

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