How the Safer Births Programme made a difference

Mr Simon Cunningham Acknowledgments to Denise Horne & Cath Murray

Developing Better Maternity Care

Conference

The King’s Fund, March 2012

Overview

• Background of the project & organisation

• Key issues & change of approach

• Timeline

• Outcomes & changes in practice

• Key lessons

• Future

Background

• The place MCHT Crewe and its surrounding areas (Population of 300,000)

• Foundation trust in 2008

• 60 hour / week labour ward cover since early 2010

• Three levels of consultant involvement

• Four heads of midwifery & three GDM / ADD’s

The safer births initiative

• Decrease CTG misinterpretation

• Decrease low cord gases

• Decrease PPH rates

• Better use of the maternity information system

The safer births initiative 2.0

• Better teamworking

• Better communication

• Adoption of national tools for patient safety

Manchester patient safety framework

• MaPSaF

• Maturity, culture & perception

• Teamworking domain scored B (reactionary)

• Ideas for service improvement

• Congruence with governance issues

Teamworking

• What defines your team?

• How easy is it to communicate ideas ?

• Roles & goals

• Loafing versus labouring

• Topdown for direction. Ground up for solutions

Initiatives

• Communication tools

• Buddy CTG system

• Birthrate acuity & NPSA intrapartum tools

• Communication of change

• Postpartum haemorrhage

SBAR

• Situation Background Assessment Recommendation

• Flattens the hierarchy

• Streamlines & standardises

• Promotes continuity

• Reduces frustration !!!

SBAR

• CHAPS used by a cluster partner

• Ownership by staff

• Mandatory training

• Distributed throughout care pathway

SBAR

• CHAPS used by a cluster partner

• Ownership by staff

• Mandatory training

• Distributed throughout care pathway

Birth rate acuity

Birth rate acuity & escalation

Birth rate acuity

• Embedding

• Escalation policy

• Audit

• Elective activity

• Low cord gases

Birth rate acuity

• Embedding

• Escalation policy

• Audit

• Elective activity

• Low cord gases

Buddy system

• Followed two root cause analyses

• Hourly (first stage), 30 mins (second stage)

• Reinforced K2 and mandatory training

• Created environment for discussion

Buddy system

It’s that Buddy time again!A fresh pair of eyes…

On the hour, every hour

Buddy system

• Ad hoc

• Not clearly understood

• Not reinforced

• Directed to problem traces

• Habit

• Guidance revised by LWC

• Drove it

• All EFM

• Rolling audit

10.00 Welcome and introductionsOverview and update on SBIN

project

• 10.15 Agreeing purpose and expectations

• A day in the life of a Labour Ward Co-ordinatorTriumphs and tribulationsLWC as leader

• 11.30 Break

• 11.50 What’s my style? How do I like to do things, how

do I work with others?

• 13.00 Lunch

• Introducing change and making it stickWorking with real issues

identifying:

Labour ward co-ordinators consultancy day

• “We have achieved more today than we might in weeks or months on the unit”

• “It has been excellent to spend the day together - it is the first time we have all been in the same room.”

• “I think we have worked together well - we have had different ideas but have been able to agree some good ways forward. It’s good to get the feeling of working as a team”

Labour ward co-ordinators consultancy day

Outcomes

• MaPSAF: B/C into C/D.

• Reactive into bureaucratic into proactive

• Triage & induction areas made

• SBAR across the board

• Escalation policy works…

• Buddy system embedded

• Dissemination of guidance/practice

What went well

• Culture versus strategy

• Cluster days

• Consultancy days

• Core days

• MDT

Timelines

Momentum

Momentum

Next time we’d

• Involve more people sooner

• Board support

• Mentor sites

• Postpartum haemorrhage

How has ……?

• Look behind the headlines

• Creating a movement

• Pseudoteams

• Sell, buy, own

• Network

• MDT works

Moving on

• Shared decision making project with AQUA

• Normality

• Antenatal care pathways

• Screening & fetal med

• Postnatal care & parentcraft

• Complex social care

• Bereavement & Post-traumatic stress

•“You don’t reduce caesarean section rates with policies and guidelines you do it by changing the people”

•Professor James Walker, first core meeting at The King’s Fund, October 2009.