simon cunningham: how the safer births programme has made a difference to quality and safety
DESCRIPTION
Simon Cunningham, Consultant at Mid Cheshire Hospitals NHS Foundation Trust, explains how his team have improved teamworking, communication and governance arrangements in their maternity services.TRANSCRIPT
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.