Midwives working in the North-West London Early Adopter (EA) project team led on a programme to implement a digital App in the 6 maternity units across the North-West London Local Maternity System. The EA project team are within the Acute Care Transformation Team, part of the North-West London Health and Care Partnership. The App aims to improve outcomes, experience and use of resources across the locality.
Where to look
NHS England’s report Better Births (2016) established a vision for maternity services across England for them to become safer, more personalised, kinder, professional and more family friendly; where every woman has access to information to enable her to make decisions about her care; and where she and her baby can access support that is centred around individual needs and circumstances. The vision is for all staff to be supported to deliver care which is women centred, working in high performing teams, in organisations which are well led and in cultures which promote innovation, continuous learning, and break down organisational and professional boundaries. The report identified the need for:
- Good quality and consistent communication;
- A joined-up approach from professionals across the sector;
- Transparent conversations about choice;
- Use of digital technology to enhance maternity care.
Within North West London, extensive user engagement via a purpose-built engagement website and face to face sessions at children’s centres revealed that women were unhappy with the inconsistency and unreliability of the information they were receiving regarding their maternity care. The midwifery team were also aware that the quality and volume of information was often conflicting and confusing. This opinion was echoed during discussions with maternity staff.
The “mum & baby” app already existed within one Trust in the sector, with its focus being on the postnatal experience. The Early Adopters project identified an opportunity to develop the App to cover the entire maternity pathway and serve all North-West London maternity services/users to address the unwarranted variation being seen in experiences and outcomes.
What to change
Before the launch of the revised mum and baby App, maternity service users in North-West London had to rely on a variety of sources to find out information about provision of care, health related information and local services. There was a high level of unwarranted variation in access to, and reliability of, information.
Better Births (2016) highlighted the importance of providing comprehensive information at all stages of the maternity experience, in an easily accessible format, but also to facilitate women’s choice and personalisation of care. Through development of the digital application, consistent high-quality information could be made easily available to users, contributing towards the safety and perinatal mental health ambitions. Additionally, it was intended that the new App would act as a single point of access / ‘digital front door’ for self-referral to the 6 maternity units, supporting local systems to fast track the implementation of recommendations from Better Births.
How to change
Once agreed by the Local Maternity System board, the Early Adopters Project Team, the project was led by a Midwife Project Manager with an interest in digital technology. The midwife provided project management of the App expansion and development from the start to the launch.
Taking a whole system approach to the design and development of the App, a core value of the project was ‘collaboration’. Midwives from across the sector were invited to participate in the development of the content. Suggestions were received from those with specialist interest in infant feeding, antenatal/postnatal care, high dependency, home birth, bereavement care amongst others. Student midwives were also invited to participate along with health visitors, physiotherapists and perinatal mental health nurses. Third sector, professional bodies and local authorities were also encouraged to contribute. Service users and their families made a significant contribution to the content development.
A working group, including IT lead midwives, consultant midwives, Maternity Voices Partnership (MVP) chairs and consultant obstetricians from each of the maternity trusts, were appointed to review and approve the content, with final sign off by the Local Maternity System (LMS) board.
Regular communication via email, teleconference and face to face meetings were undertaken as the App progressed. Prototypes were built and revised as a result of service user and clinician testing.
The final application was launched to the public in November 2018, promoted via GP surgeries, children’s centres and pharmacies across North-West London. To monitor the impact, monthly metrics are collected on:
- Number of users;
- Number of users selecting a specific maternity unit;
- Number of ‘personal care plan’ downloads;
- Length of interaction with app content.
Better outcomes – To date, the App has been downloaded by over 4000 users and maternity staff. The App aims to improve women and families’ experience of maternity care, specifically supporting 100% of women being offered digital personal care plans, an increase in meaningful choice for women using services, increased safety and self-referrals and early bookings to meet the 10 weeks plus 6 days target. Women are attending appointments with a better understanding of the service and of what to expect which means they are better prepared and the consultation can be used to benefit them the most. Service users have quicker access to information to support their choices and manage their own health.
Better experience – The team has received positive feedback from the women who have already accessed the App. Examples include:
“I never knew there was so much to know and this App helps to keep it all in one place. Easy to use. Brilliant.”
“It has done so much to help me understand what to expect during pregnancy and birth.”
Staff have also welcomed the App:
“Packed with information. A great support for pregnancy, birth and beyond.” (midwife comment)
“This App offers women in NW London clear and straightforward information about their pregnancy, birth and the care that they can expect. It will be great for women to have all this info at their fingertips.” (midwife reviewer)
Better use of resources – Staff report that the App has streamlined processes for women leading to less duplication which has freed up clinician time. Owing to the success of “mum and baby” in North-West London, the LMS has developed a Business Case to enable other Local Maternity Systems to purchase and adapt the App for their own use. Maternity units across the sector are continuing to collaborate closely on the production of information. They are working closely with their communications teams to integrate the App with their maternity websites.
Challenges and lessons learnt for implementation
The Project Management team needed a high degree of flexibility and availability in collaborating with multiple groups of stakeholders. Whilst co-producing the App was challenging at times, this approach has been and will continue to be the key to its success.
It was important to recognise and understand the skills and expertise of all those involved in the development. It was also important to set clear aims from the outset.
A significant challenge has been managing multiple voices, ensuring that all voices and opinions were heard equally and reflected within the finished product.
The team quickly learnt the value of seeking advice from others within the NHS who already have the skills of App development. This enabled the project team to anticipate potential barriers and pitfalls.
For more information contact
Project Manager – Maternity Transformation Programme, North-West London Health and Care Partnership (STP)
NHS North-West London Collaboration of CCGs
Helen.firstname.lastname@example.org or email@example.com