The Midwifery Unit Self-Assessment (MUSA) Toolkit: embedding stakeholder engagement and co-production of improvement plans in European midwifery units

Background: For women with straightforward pregnancies midwifery units (MUs) are associated with improved maternal outcomes and experiences, similar neonatal outcomes, and lower costs than obstetric units. There is growing interest and promotion of MUs and midwifery-led care among European health policymakers and healthcare systems, and units are being developed and opened in countries for the first time or are increasing in number. To support this implementation, it is crucial that practice guidelines and improvement frameworks are in place, in order to ensure that MUs are and remain well-functioning.Aims and objectives: This project focused on the stakeholder engagement and collaboration with MUs to implement the Midwifery Unit Self-Assessment (MUSA) Tool in European MUs. A rapid participatory appraisal was conducted with midwives and stakeholders from European MUs to explore the clarity and usability of the tool, to understand how it helps MUs identifying areas for further improvement, and to identify the degree of support maternity services need in this process.Key conclusions: Engagement and co-production principles used in the case studies were perceived as empowering by all stakeholders. A fresh-eye view from the external facilitators on dynamics within the MU and its relationship with the obstetric unit was highly valued. However, micro-, meso- and macro-levels of organisational change and their associated stakeholders need to be further represented in the MUSA-Tool. The improvement plans generated from it should also reflect these micro-, meso- and macro-level considerations in order to identify the key actors for further implementation and integration of MUs into European health services.Key messagesEngagement and co-production principles used in the case studies were perceived as empowering by all stakeholders.A fresh-eye view from the external facilitators were highly valued by stakeholders.Micro-meso-macro levels of change need to be further represented in the MUSA-Tool.The high impact actions need to reflect the micro-meso-macro levels to identify the correct players.