Table 5 Themes and sub-themes with example quotes

1. Communication

1.1 Improving communication strategies

It’s having access to the practice standards that are all printed in the MORE^OB, like all the clinical knowledge and then learning some of the communication pieces, like the Take Five and learning to debrief after even a normal delivery and using like the SBAR and things, so utilizing that in practice. (Interview 1A – Registered Nurse, Post-Module 2)

1.2 Interprofessional communication

There’s been increased engagement amongst and between the groups participating, so midwives, physicians and nurses. So we’re certainly talking about stuff together. (Interview 3A - Family Physician, Post-Module 2)

2. Knowledge

2.1 The knowledge itself

2.1.1 Accessible

I have really liked the availability to go on to see the modules online, you know, at the drop of a hat. We have electronic medical record at our hospital so there’s computers all over the place. So it’s quick. It’s easy to access things. (Interview 5A – Family Physician, Post-Module 2)

2.1.2 Evidence-based

Instead of my searching for all the guidelines and going into ACOG and SOCG, it’s [MORE^OB] kind of one-stop shopping, right? So then it’s kind of like I always say ‘yes, these are guidelines and our clinical judgement comes into play, but this is kind of what MORE^OB summarizes,’ which is always up-to-date because they’re looking at it from a yearly basis and they’re collectively gathering the data so I don’t have to, so it saves me a ton of time that way. (Interview 1B – Registered Nurse, Post-Module 3)

2.1.3 Canadian/SOGC

So because the information was very readable, because it’s Canadian based with SOGC back-up and I’ve done the ALARM course a few times so it’s basically the same content. So it’s something we feel we can buy into. It’s something we feel like this is the norm. This is the expectation. This has been researched. This makes sense. (Interview 3A – Family Physician, Post-Module 2)

2.2 Sharing the same knowledge and language

So we have some content resources and some communication resources to refer to and so when they’re talking to me about something, then I know that we’re talking about the same thing. I know what they’re saying and that what I’m saying to them is sort of being understood on the same level. (Interview 14A – Obstetrician, Post-Module 3)

2.3 Increased knowledge

For us, our education program for our labour and delivery nurses were they got six shifts in a labour … they didn’t even have to see a delivery to be an OB nurse … So that was kind of the education level when I started here and of course, because we only do 100 deliveries a year, it’s hard for them to get enough volume. So in a centre like ours, I think you can really see the impact of a program like this. (Interview 9A - Family Physician, Post-Module 2)

3. Safer care

3.1 Concrete changes

Previously there were a number of pieces of equipment we didn’t have in the room so we’ve acquired equipment, just there was a lot of that happening actually where it’s like ‘oh my gosh, like we don’t even have these things’ … I think probably in some cases people recognized issues in the past but didn’t have a way of communicating those concerns so I think frequently there was nothing to sort of back them up and show why this should be changed. And now with MORE^OB it gave the research and the explanation of here are the things you should try to implement in your site. (Interview 4B – Registered Midwife, Post-Module 3)

3.2 Changes to how we deliver care

3.2.1 Collaboration between HCP

I really believe that because of the MORE^OB principles of teamwork and openness and transparency and the debriefing methods that the safety for the actual client has improved markedly. (Interview 6A - Registered Nurse, Post-Module 2)

3.2.2 Collaboration with women

There’s much more strengthened education that nurses are sharing with patients, helping them to better understand even when things are going in a difficult direction for a patient, helping them and their partners to better understand what’s unfolding and what to expect. (Interview 7B – Administrator, Post-Module 3)

3.3 Improving outcomes

We had a post-partum hemorrhage the other day and how it was handled, again because of those modules and knowing the steps to perform, they were done quickly and that situation was dealt with. And again, the mom was okay and the baby was okay after the crisis had occurred. (Interview 11A - Registered Nurse, Post-Module 3)

4. Increased confidence

4.1 In yourself

It’s more confidence and being empowered. Doing the MORE^OB program empowers us to have knowledge first of all, but also gives us ways to communicate to each other and just mobilizes it. It just makes you feel empowered to speak your mind. And no questions or no comments are wrong, that it’s an opportunity to learn. (Interview 12A - Registered Nurse, Post-Module 3)

4.2 In others

But I think what it [MORE^OB] does for their group is I think it begins to increase not only their confidence in their co-workers but their expectations of their co-workers … they know that this knowledge is available at present and expectation and can have confidence that their team, even if they’re not really experienced team members, are expected to know this. (Interview 10A - Registered Nurse, Post-Module 3)

5. Program implementation

5.1 Influencing factors

5.1.1 Individual

My nursing staff in particular have been incredibly hungry around new knowledge and this is really, the timing of this program has been perfect for them and we don’t have a dedicated nursing educator here in our small hospital and so they’ve really, really, really expressed incredible gratitude in terms of being able to participate in this program. (Interview 7A – Administrator, Post-Module 2)

5.1.2 Organizational

I mean I think we all had pretty high hopes that this was going to sort out some issues and problems. And I think one of the biggest learnings for me is that the best education program in the world can’t solve a culture issue if you don’t have leadership and you don’t have people walking the talk and really bringing home the importance of those issues, it’s not going to stick or people aren’t going to really adopt the behaviour change and people revert back to their old ways pretty quickly. (Interview 13A - Family Physician, Post-Module 3)

5.2 Sustainability

You can’t do a program for three years and they rub their hands and say we’re done now. There has to be ongoing passing the talent on in the correct way. This is what the basis of our unit is and it should be across the whole organization. (Interview 12A - Registered Nurse, Post-Module 3)