Communication failures and racial disparities in inpatient maternity care: a qualitative content analysis of incident reports.

Background: Severe maternal morbidity (SMM) and mortality disproportionality affect Black women in the USA. Communication failures are a leading cause of poor maternal outcomes. We examined incident reports to identify communication failures within inpatient maternity care and racial disparities therein.

Methods: We analysed de-identified incident reports submitted by hospital staff working on antepartum, labour and birth, and postpartum in an urban, academic hospital between 2019 and 2022. Reports were linked to electronic health records to capture race and SMM outcome. We conducted qualitative content analyses using a constant comparative method and an inductive and deductive approach. We explored communication failures by race/ethnicity and SMM outcome. In vivo themes included equity and positive communication.

Results: We identified 541 communication failures within a random sample (n=1006) of incident reports across the study period. Black women represented 28% of births during this time, but 38% of the incident reports. Most of the communication failures occurred within the healthcare team rather than with patients. Communication failures were, broadly, contextual (eg, audience, who was present), conceptual (eg, lack of shared understanding) or sociotechnical (eg, computer-human interface). Of the incident reports coded as contextual failures, errors of omission were the most common. Most conceptual failures were a lack of shared understanding. Sociotechnical failures were predominantly workflow and communication and internal organisational features.

Conclusions: Our findings suggest that if we want to address communication failures as a root cause of maternal morbidity and mortality, we need to focus on the quality of communication within the healthcare team. These efforts should concentrate on decreasing omission and building shared understanding of responsibilities and processes, especially when teams are caring for Black women.