Improving maternity services is a marathon, not a sprint

NHS England’s Experience of Care Lead for Maternity, Infants, Children and Young People reflects on how two recent projects have helped services move forward to embed a spirit of continuous improvement and listening:

I’m a marathon runner. I’m not a very fast one and have only done one before but I’m now in training for the Loch Ness Marathon next month.

Outside work, it occupies much of my thinking time: how to get the training miles in, avoid injury and ensure I have the right amount of carbs to fuel my training.

Reflecting on how far my training has come got me thinking about how much progress is being made in continuing to work to improve maternity experiences. We only have to look at #MatExp #BetterBirths on Twitter for inspiration to keep us going on the marathon of improving maternity experiences, and improving maternity experiences is certainly a marathon not a sprint.

The Maternity Challenge Fund, launched in 2016, offered just that encouragement to maternity services, a bit like the kindly spectator handling out jelly babies on the marathon route to keep us focused and moving forward.

In that first year, University Hospitals of Morecambe Bay and Kingston Hospital NHS Foundation Trust took up the national #MatExp challenge and stretched themselves believing they could do even more to improve experiences of maternity care. They have now filed their final project reports and have made toolkits from their learning available to other trusts.

Morecambe Bay provides integrated midwifery, obstetric and neonatal care in both the community and hospital settings. Feedback from service users, about antenatal, labour, birth and post-natal experiences is obtained using a variety of different methods including the Friends and Family Test.

The significant theme emerging from their feedback was that there was an opportunity to address communication issues, as it was this that was leading to negative maternity experiences.

Working with the Maternity Service Liaison Committee, a project group was formed and 16 powerful stories from women were captured and form the basis of an intense multi-professional communication training toolkit developed in conjunction with Salford University. It is aimed at all professions who may support women and their families whilst using maternity services. Films describe how the communication styles of the health professions who women met throughout their maternity experience impacted on them and their families.

No-one runs a marathon in the same way and a different approach was taken by Kingston Hospital NHS Foundation Trust, who led a project called Nobody’s Patient, supported by the London Maternity Strategic Clinical Network (SCN) and hosted within the Medical Directorate of NHS England London region.

In 2014 the London SCN responded to the poor Care Quality Commission maternity survey results by bringing staff and users of services together at #MatExp workshops to identify solutions. The workshops are based on the WhoseShoes?® approach which is a values-led, bespoke approach to change management in the form of an engaging board game, developed by Nutshell Communications Ltd. The approach uses poems and scenarios to stimulate conversations between users of services and practitioners in a workshop setting, creating ideas for improvement and pledges for action by attendees.

Kingston Hospital NHS Foundation Trust applied to the Maternity Challenge Fund as they were aware further work was required with three ‘seldom heard’ groups:

  • Families with babies in neo-natal units (NNU).
  • Severely ill women and women who are faced with an unexpected life-threatening illness.
  • Women who miscarry at mid-term.

The project produced in excess of 100 new scenario cards and 12 poems across the three groups. They held two successful test workshops across SW London maternity network and workshops addressing the challenges faced by these “seldom heard” women are now taking place across the country.

Pledges made as a result of the workshops and already completed include: the introduction of iPads so that parents can Skype babies from home; introduction of diaries for babies to facilitate communication between parents and staff; and rewording the letter sent out to parents when a risk investigation has been instigated to make it more user friendly.

Improving maternity experiences requires us all to keep engaging and working together with the women and families that we care for. Importantly we need to keep sharing our “marginal gains” across England and beyond.

Please do seek out further information from Kingston and Morecambe Bay and consider how you can use their learning in your own marathon journey of improving maternity experiences of care.

Kath Evans

Kath Evans, RGN, RSCN, MSc (Nursing), PG Dip (Education), BSc (Hons), PG Dip (Management), Institute of Leadership and Management (ILM) Accredited Coach, is NHS England’s Experience of Care Lead – Maternity, Infants, Children and Young People.

She is a registered general and children’s nurse and her career has included clinical, educational, managerial and service improvement roles.

She is committed to ensuring the voices of children, young people, families/carers and maternity service users are heard in their care and in the design, delivery and commissioning of services.

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  1. Caroline Wright says:

    Really fantastic to hear about these approaches. As a marathon runner (quite a few years ago!) and an obstetrician, I can relate to both challenges. Will be looking at the toolkits for inspiration for my own unit: Royal Free Hospitals NHS Foundation Trust