Strategies for Patient Safety Implementation in Independent Midwifery Practices: A Systematic Literature Review
Mozha Desri Puji Astuti1*,Yudhy Dharmawan1*,Daru Lestantyo1*,Nurjazuli1*

1 Faculty of Public Health Diponegoro University, Indonesia

Abstract

Background: Patient safety remains a critical concern in maternal health, particularly within independent midwifery practices that often operate with varied degrees of integration into national health systems. While numerous strategies have been proposed to enhance safety, their effectiveness is shaped by the conditions of implementation.
Objective: This systematic literature review aims to (1) identify and analyze strategies proposed to enhance patient safety in independent midwifery practices and (2) explore the barriers and facilitators commonly reported during implementation.
Methods: Guided by the PRISMA 2020 framework, a structured search was conducted in Scopus and PubMed for open-access articles published between 2015 and 2025. From an initial pool of 606 records, 35 studies met the inclusion criteria. Thematic analysis was employed to synthesize findings across varied global settings and care models.
Results: Seven thematic categories of patient safety strategies were identified: clinical guidelines and governance, simulation-based training, psychological safety and fatigue management, continuity of midwifery-led care, culturally inclusive practice, interdisciplinary collaboration, and community engagement. Five major themes of barriers and facilitators emerged: systemic policy limitations, organizational and infrastructural constraints, knowledge and skill gaps, socio-cultural challenges, and psychological safety dynamics. Effective implementation was consistently supported by stakeholder engagement, flexible care models, mentorship programs, and leadership support.
Conclusion: Improving patient safety in independent midwifery requires not only evidence-based interventions but also enabling environments that support their sustainability. A holistic, context-sensitive approach-addressing both clinical and cultural dimensions-is essential to advancing midwifery care quality and maternal outcomes globally.

Keywords: patient safety, midwifery, implementation, strategy, barriers, facilitators, independent practice, systematic review.

Topic: Public Health Sciences