Bingji Bingji Booris (Heavily pregnant to babies – Yuin Language)

Project Evaluation

Jackie Jackson Aboriginal Health Manager

Amanda Gear Clinical Midwifery and Maternity Risk Management Consultant

Acknowledgement of Country

We would like to acknowledge and pay our respects to the first people, the Gadigal people of the Eora nation, past, present and future and all

other Aboriginal people here today we recognise the continuing connection of Aboriginal and Torres Strait Islander peoples to their

country, lands and family.

BackgroundCase for change• The continuum of care for women accessing Aboriginal Maternal

Infant Health Service (AMIHS) was fragmented

• Only 14% of women were booking in before 14 weeks

• Near misses and adverse incidents highlighted the need for early access and referrals for support

• Women’s and stakeholder’s stories demonstrated that Aboriginal Cultural Awareness and Sensitivity could be strengthened.

• Makita’s journey

Mapping AMIHS Woman’s Journey

AMIHS Women

and Families

Objectives1. By July 2016 50% AMIHS women will be booked in before 14

weeks2. By December 2015 Implement the recommended standards

for Diabetes Screening, Renal Diseases and Quit Smoking3. To increase the postnatal continuity of care capacity so that

100% AMIHS women will be followed up by the AMIHS Midwife for two weeks after birth

Methods• Women’s stories guided by

Indigenous Pie (10)• Staff interviews (10)• Tagalongs (3)• Process Mapping• Key Performance Indicators• Brainstorming workshops• One to one consultations (12)• Consultation with external stakeholders• Literature search• Incident Information Management System (IIMS) review• Complaints review

Summary of Key Issues – The 3 Cs

• Continuity of Care86% of women did not receive early assessment & intervention

• Cultural AwarenessThere was poor compliance to the Respecting The Difference e-learning

• Cultural AestheticsSome of the AMIHS women identified that the maternity service environment was not culturally welcoming for them

Respecting the

Difference Training

AMIHSStaff

MaternityStaff

Dec 2014 0% 0%

April 2015 100% 15%

Dec 2015 100% 100%

The New Journey for AMIHS WomenMy ideal Maternity Service would be…..The home visits are convenient, the supports are amazing, the ability to call with concerns when needed - great, as at times maternity at the hospital is too busy or too clinical for me to understand

(Melissa, reflecting on things after one year)

Summary of Key Solutions1. Raising Cultural Awareness and Aesthetics• Managers - monitor

compliance with HETI eLearning

• Cultural Inclusion Checklist (Maternity Services) – complete and implement

• Develop and facilitate the Respecting the Difference face-to-face training for all Maternity staff

Summary of Key Solutions cont.2. Standardized the clinical pathways and continuity of support• Improve community

awareness about early access with the use of approved social media

• Adapt clinical pathways to include culturally appropriate service delivery and educate staff in VTE, diabetes and renal screening

• Ensure continuity of care with known Midwife and Aboriginal Health Worker

Summary of solutions cont

3. Develop and support the local workforce • Clinical Supervision • New Directions Funding to enhance the Allied Health

support• Providing leave relief for clinicians (backfilling)• Implement Intake Meetings • Include in Perinatal reviews• Aboriginal Health Workforce Strategy

Implementation SequencingWe are

here

Results to DateOn Target

In Progress

1. By July 2016 50% AMIHS women will be booked in before 14 weeks

2. By December 2015 Implement the recommended standards / assessments for Quit Smoking, Diabetes, Renal Diseases, VTE screening

• VTE screening draft tool in progress

• Awaiting for CEC maternity package

To increase the postnatal continuity of care so that 100% AMIHS women will be followed up by the AMIHS Midwife for two weeks after birth

• Still a challenge due to workload and workforce constraints

• Need to seek additional resources for clinical staff hours for continuity of care

• Recruitment of AMIHS Manager progressing – unable to recruit for 7 months

Results to DateOther benefits achieved:• Information exchange from other Aboriginal

Health programs to assist to review practices and models of care

• Successful applications to date:New Directions (Commonwealth Dept Health) for Allied Health enhancement to AMIHS

• Capital Works to enhance the workplace/clinic space for AMIHS Women and staff - culturally appropriate and safe

AMIHS clinic and work spaces• Trauma informed care training• Smoking cessation workshops attended• The Maternity Service is interested in Redesign Processes to

establish a Midwifery Group Practice!

The Next Steps1. Continue with implementing Respecting the Difference face to face training

2. Improve pregnancy screening and clinical pathways

3. Continue and improve communication with clinicians

4. Continue learning from women’s stories

5. Recruit the AMIHS Team Leader

6. Continue to explore ways to fund and offer full of continuity of care through pregnancy, labour, birth and postnatal care so that we can have the first sustainable AMIHS continuity of care program in NSW

7. Share lessons learned with AMIHS services in SNSWLHDS and across the State.

8. Inspire Eurobodalla Maternity Service to use Redesign Methodology to explore Midwifery Group Practice models

Lessons learned during the Implementation Phase• The importance of valuing and understanding women’s

stories and their individual journeys This impacts significantly on how our care may impact upon women’s lives.

• That Respecting the Difference Training makes a difference by increasing the awareness of complexities.

• Culturally sensitive and appropriate environments Aesthetics are important for women and also for clinicians.

• Community development is an essential part of engagement with women and their journey.

• Sharing lessons learned supports others when developing and enhancing continuity of care paths

Acknowledgements• Women and families who have generously shared their stories,

enabled tagalong experiences, assisted and donated photos for the project. Coolamon made by Raw Kreations - Mary Moore for her nephew baby Alfred Moore

• SNSWLHD Executive Sponsor - Executive DONM Julie Mooney & Cherie Puckett, Nurse Manager Leadership and Practice Development

• Steering Committee and Project Team members

• AMIHS/BSF Manager and Clinicians

• Eurobodalla Maternity Services Management, Clinicians and SNSWLHD Clinical Midwifery Consultant

• SNSWLHD Manager Redesign & Innovation - Judith Hallam

• Support from everyone at the NSW Agency for Clinical Innovation

Thank you Any Questions?