COMPASS (Culture of Organisations and its iMPact on PAtientS’ Safety), a tool developed to help healthcare staff identity and address cultural factors affecting patient safety in maternity services, has had positive feedback in its first pilot study.

The tool provides an evidence-based framework for documenting observations on organisational cultures within maternity and newborn services. COMPASS was developed in response to research which identified recurring cultural issues that were linked to patient safety concerns.

The pilot involved 12 NHS trusts and used 21 domains to capture both positive and negative cultural observations from closed investigation cases. Findings were then shared with trust leadership teams to encourage discussion and learning.

The majority of MNSI staff who participated in the pilot, via focus groups and surveys, found COMPASS helpful for discussing and documenting safety culture observations. Trust feedback, while limited in number, was encouraging. Almost all respondents felt COMPASS provided valuable insights into how organisational culture impacts patient safety, with most planning to take action based on the results.

Dr Chris McQuitty, MNSI Clinical Fellow said: “COMPASS has given us a structured way to see how culture really affects patient safety. The insights from the pilot are already helping trusts focus on learning and improvement.”

Lessons were learnt from this pilot and several areas for development were identified, including improving the scoring system and allowing staff to record observation in real-time rather than retrospectively.

These initial findings demonstrate COMPASS’s potential to help maternity services strengthen their reporting of safety culture observations.

Based on the initial pilot study, MNSI is now developing an updated version of COMPASS incorporating the learnings and feedback from MNSI staff and trusts. A second pilot is planned to begin in February 2026.

COMPASS Pilot 1 Findings - PowerPoint slide deck

COMPASS Pilot 1 Findings - Executive Summary (.docx)

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