1.
How the Safer Births Programmemade a differenceMr Simon CunninghamAcknowledgments to Denise Horne & Cath MurrayDeveloping Better Maternity Care ConferenceThe King’s Fund, March 2012

2.
Overview• Background of the project & organisation• Key issues & change of approach• Timeline• Outcomes & changes in practice• Key lessons• Future

3.
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

4.
The safer births initiative• Decrease CTG misinterpretation• Decrease low cord gases• Decrease PPH rates• Better use of the maternity information system

5.
The safer births initiative 2.0• Better teamworking• Better communication• Adoption of national tools for patient safety

6.
Manchester patient safety framework• MaPSaF• Maturity, culture & perception• Teamworking domain scored B (reactionary)• Ideas for service improvement• Congruence with governance issues

7.
Teamworking• What defines your team?• How easy is it to communicate ideas ?• Roles & goals• Loafing versus labouring• Topdown for direction. Ground up for solutions

8.
Initiatives• Communication tools• Buddy CTG system• Birthrate acuity & NPSA intrapartum tools• Communication of change• Postpartum haemorrhage

9.
SBAR• Situation Background Assessment Recommendation• Flattens the hierarchy• Streamlines & standardises• Promotes continuity• Reduces frustration !!!

10.
SBAR• CHAPS used by a cluster partner• Ownership by staff• Mandatory training• Distributed throughout care pathway

11.
SBAR• CHAPS used by a cluster partner• Ownership by staff• Mandatory training• Distributed throughout care pathway

12.
Birth rate acuity

13.
Birth rate acuity & escalation

14.
Birth rate acuity• Embedding• Escalation policy• Audit• Elective activity• Low cord gases

15.
Birth rate acuity• Embedding• Escalation policy• Audit• Elective activity• Low cord gases

16.
Buddy system• Followed two root cause analyses• Hourly (first stage), 30 mins (second stage)• Reinforced K2 and mandatory training• Created environment for discussion

17.
Buddy system It’s that Buddy time again! A fresh pair of eyes… On the hour, every hour

18.
Buddy system • Habit• Ad hoc • Guidance revised by LWC• Not clearly understood • Drove it• Not reinforced• Directed to problem • All EFM traces • Rolling audit

19.
Labour ward co-ordinatorsconsultancy day 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:

20.
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”

21.
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

22.
What went well• Culture versus strategy• Cluster days• Consultancy days• Core days• MDT

23.
Timelines

24.
Momentum

25.
Momentum

26.
Next time we’d• Involve more people sooner• Board support• Mentor sites• Postpartum haemorrhage

27.
How has ……?• Look behind the headlines• Creating a movement• Pseudoteams• Sell, buy, own• Network• MDT works

28.
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

29.
• “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.