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

• A ll EFM

• Rolling audit

10.00 Welcome and introductions Overview and update on SBIN project

• 10.15 Agreeing purpose and expectations

• A day in the life of a Labour Ward Co-ordinator Triumphs and tribulations LWC 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 stick Working 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.