Simon Cunningham: How the Safer Births Programme has made a difference to quality and safety
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Transcript of Simon Cunningham: How the Safer Births Programme has made a difference to quality and safety
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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
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Overview
• Background of the project & organisation
• Key issues & change of approach
• Timeline
• Outcomes & changes in practice
• Key lessons
• Future
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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
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The safer births initiative
• Decrease CTG misinterpretation
• Decrease low cord gases
• Decrease PPH rates
• Better use of the maternity information system
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The safer births initiative 2.0
• Better teamworking
• Better communication
• Adoption of national tools for patient safety
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Manchester patient safety framework
• MaPSaF
• Maturity, culture & perception
• Teamworking domain scored B (reactionary)
• Ideas for service improvement
• Congruence with governance issues
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Teamworking
• What defines your team?
• How easy is it to communicate ideas ?
• Roles & goals
• Loafing versus labouring
• Topdown for direction. Ground up for solutions
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Initiatives
• Communication tools
• Buddy CTG system
• Birthrate acuity & NPSA intrapartum tools
• Communication of change
• Postpartum haemorrhage
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SBAR
• Situation Background Assessment Recommendation
• Flattens the hierarchy
• Streamlines & standardises
• Promotes continuity
• Reduces frustration !!!
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SBAR
• CHAPS used by a cluster partner
• Ownership by staff
• Mandatory training
• Distributed throughout care pathway
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SBAR
• CHAPS used by a cluster partner
• Ownership by staff
• Mandatory training
• Distributed throughout care pathway
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Birth rate acuity
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Birth rate acuity & escalation
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Birth rate acuity
• Embedding
• Escalation policy
• Audit
• Elective activity
• Low cord gases
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Birth rate acuity
• Embedding
• Escalation policy
• Audit
• Elective activity
• Low cord gases
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Buddy system
• Followed two root cause analyses
• Hourly (first stage), 30 mins (second stage)
• Reinforced K2 and mandatory training
• Created environment for discussion
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Buddy system
It’s that Buddy time again!A fresh pair of eyes…
On the hour, every hour
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Buddy system
• Ad hoc
• Not clearly understood
• Not reinforced
• Directed to problem traces
• Habit
• Guidance revised by LWC
• Drove it
• All EFM
• Rolling audit
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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
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• “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
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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
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What went well
• Culture versus strategy
• Cluster days
• Consultancy days
• Core days
• MDT
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Timelines
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Momentum
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Momentum
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Next time we’d
• Involve more people sooner
• Board support
• Mentor sites
• Postpartum haemorrhage
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How has ……?
• Look behind the headlines
• Creating a movement
• Pseudoteams
• Sell, buy, own
• Network
• MDT works
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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
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•“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.