Braun V, Clarke V Thematic analysis: a practical guide.London: Sage Publications Ltd; 2022

Coulter A, Locock L, Ziebland S, Calabrese J Collecting data on patient experience is not enough: they must be used to improve care. Br J Med. 2014; 348

Doyle C., Lennox L., Bell D A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open. 2013; 3

Engle RL, Mohr D, Holmes SK Evidence-based practice and patient-centred care: doing both well. Health Care Manage Rev. 2021; 46:(3)174-184

Field F The foundation years: preventing poor children becoming poor adults. The report of the independent review on poverty and life chances.London: Great Britain Cabinet Office; 2010

Flaherty S, Delaney H, Matvienko-Sikar K, Smith V Maternity care during COVID-19: a qualitative evidence synthesis of women's and maternity care providers' views and experiences. BMC Pregnancy Childbirth. 2022; 22:(438)

Fletcher A, Murphy M, Leahy-Warren P Midwives' experiences of caring for women's emotional and mental well-being during pregnancy. J Clin Nurs. 2021; 30:(9-10)1403-1416

Gleeson H, Calderon A, Swami V, Deighton J, Wolpert M, Edbrooke-Childs J Systematic review of approaches to using patient experience data for quality improvement in healthcare settings. BMJ Open. 2016; 6:(8)

Jenkins M, Ford J, Todd A, Forsyth R, Morris J, Roberts C Women's views about maternity care: how do women conceptualise the process of continuity?. Midwifery. 2015; 31:(1)25-30

Saving lives, improving mothers' care: lessons learned to inform maternity care from the UK and Ireland confidential enquiries into maternal deaths and morbidity 2019-2021. 2023. https// (accessed 16 November 2023)

Koblinsky M, Moyer C, Calvert C, Campbell J, Campbell O, Feigl A Quality maternity care for every woman, everywhere: a call to action. Lancet. 2016; 388:(10057)2307-2320

Lalor J, Sheaf G, Mulligan A Parental experienced with changes in maternity care during the Covid-19 pandemic: a mixed-studies systematic review. Women Birth. 2023; 36:(2)203-212

Larsen E, Sharma J, Bohren M, Tuncalp O When the patient is the expert: measuring patient experience and satisfaction with care. Bulletin: World Health Organization. 2019; 97:563-569

Lisonkova S, Haslam M, Dahlgren L, Chen I, Synnes A, Lim K Maternal morbidity and perinatal outcomes in rural versus urban areas. CMAJ. 2016; 188:(17-18)E456-E465

Luxford K, Safran DG, Delbanco T Promoting patient-centred care: a qualitative study of facilitators and barriers in healthcare organisations with a reputation for improving the patient experience. Int J Quality Health Care. 2011; 23:(5)510-515

McRae DN, Muhajarine N, Stoll K Is model of care associated with infant birth outcomes among vulnerable women? A scoping review of midwifery-led versus physician-led care. SSM-Population Health. 2016; 31:(2)182-93

Ockenden D Findings, conclusions and essential actions from the independent review of maternity services at the Shrewsbury and Telford Hospital NHS Trust.London: HH Associated Ltd; 2022

Royal College of Obstetricians and Gynaecologists. Review of maternity services at Cwm Taf Health Board. 2019. https// (accessed 9 April 2024)

Sandall JS The contribution of continuity of midwifery care to high quality maternity care.London: Royal Collage of Midwives; 2017

Welsh NHS Confederation. Rural health and care services in Wales. 2018. https// (accessed 9 April 2024)

Zakkar MA, Janes C, Meyer S Barriers and reliability of patient experience evaluation in Ontario: perspectives of healthcare providers, managers and policymakers. Int J Health Governance. 2022; 27:(3)

Qualitative service evaluation of a rural midwife-led ultrasound service: listening to women

02 May 2024
Volume 32 · Issue 5



Patient experience is needed to understand if a service is meeting the needs of the population it serves. In rural areas, accessing maternity services can be challenging for women. Local provision should be explored and consistently reviewed to adapt to changing social requirements and expectations. The aim of this study was to examine a rural midwifery-led ultrasound service 5 years after implementation and post COVID-19, to ascertain if the service provides a positive service user experience.


A qualitative service evaluation was carried out using semi-structured interviews with four service users. Data were analysed using content analysis.


Positive aspects of the service included continuity of care, communication, time to care, financial benefits and inclusivity in care and care decisions. It was noted that the ultrasound service was in the opposite direction from their homes to the obstetric service if participants needed to be referred for consultant opinion the same day. The significant underlying theme was the positive impact on mental wellbeing and patient experience in pregnancy when attending the service.


There was a high level of satisfaction with the service. Engagement of a broader spectrum of women would provide deeper insight into the service and robust evidence for any service development.

In the last 10 years, there has been a drive towards evidence-based practice and patient-centred care to improve clinical effectiveness and patient safety through the inclusion of patient experience in healthcare quality improvement (Luxford et al, 2011; Doyle et al, 2013). All health boards in Wales are under scrutiny to ensure that they have high standards of maternity care, and that quality improvement is forefront in providing a safe and effective maternity service that provides equity and engagement for service users. Several health board reviews cite ‘listening to the women using the service’ as an essential element in patient care and service evaluation (Royal College of Obstetricians and Gynaecologists, 2019; Kirkup, 2022; Ockenden, 2022). On 1 April 2023, the Health and Social Care (Quality and Engagement) (Wales) Act came into force, requiring improvements in communication and engagement through a citizens advice body to ensure service user experience is used to drive forward improvement. The Act expands on the duty of quality to include not only safe and effective care, but also person-centered, timely, efficient and equitable care.

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