As local areas prepare to take forward the recommendations of the national maternity review, Lillie Wenzel, Policy Fellow at The King’s Fund, considers the role of user feedback in driving improvements in maternity services.
‘You don’t know you’ve got a good service, unless women are confirming that that’s how it felt for them’.
This sentiment was expressed by many of the people we spoke to as part of our research commissioned by the Department of Health, presented in the report User feedback in maternity services. It supports a principle well established across the NHS: that the experience of the service user is a key component of quality, and tracking that experience has an important role to play in monitoring services. For providers, understanding where users report poor experiences is key to identifying problem areas and shaping service improvements.
In the context of maternity services, the case for focusing on the experiences of women and their families is easily made; the birth of a child is a unique and life-changing event which can have a long-term impact on those involved. As the national maternity review noted, there are many factors – other than the final outcome – that determine whether or not women report a positive experience of childbirth. The critical relationship between experience and quality of care is clearly reflected in the review’s vision for maternity services; they must not only be safer but also ‘more personalised’ and ‘kinder’.
Of course, gaining a clear – and representative – picture of that experience is not straightforward. Collecting feedback from service users is one of the primary methods NHS providers have for doing this, and since the early 2000s there have been a number of centrally-developed tools in place to help them. In maternity services these include the Care Quality Commission’s maternity services survey (introduced in 2007), which collects feedback every 2-3 years, and the Friends and Family Test (extended into maternity services in 2013), which is designed to gather feedback in real time.
The good news is that many organisations have not stopped there. Our research, set out in our report, found that providers are also using a wide range of locally developed tools. These include methods for capturing unsolicited feedback, such as that provided in online forums, as well as more tailored approaches that proactively seek feedback from users, such as comment cards and maternity ‘graffiti boards’. At two of the organisations we spoke to, maternity services were participating in trust-wide ‘mystery shopper’ programmes, in which volunteers from within their user group were tasked with reporting back on their experience of key aspects of the service.
To gain the best insight into women’s experiences, organisations need to hear from as wide a range of users as possible. Our research found that those with the most developed approaches to feedback collection are using a wide variety of tools to help do this. This means ensuring there are tools in place to meet the needs of those who tend not to engage with traditional approaches, as well as methods tailored to the particular needs of the local population. For example, we heard about surveys developed in different languages, and a maternity services liaison committee (MSLC) run focus group aimed at vulnerable women.
In an attempt to strengthen providers’ ability to monitor service-users’ experience of maternity services, the national maternity review recommended that NHS England consider commissioning a set of measures equivalent to patient-reported outcome or experience measures (PROMs/PREMs), to ensure that information on experience is made available in a systematic way to both providers and commissioners. The review sets this within the context of a learning culture, in which teams, organisations and systems are able to access the information they need in order to improve.
Indeed, an important message from our research is that getting the most out of user feedback – or any insight into the users’ experience – relies on much more than effective collection tools or measures. Demonstrating that this feedback is listened to and acted upon is critical in closing the feedback loop and ensuring that both users and staff remain engaged with feedback activities. This, in turn, relies upon organisations having a clear view of the purpose of feedback, leaders at all levels who champion these activities, and a culture in which the voice of users is valued as a driver for change.
How to make the most of user feedback is just one of the issues we will be discussing at our conference Shaping the future of maternity care in early November. The conference will bring together national leaders and innovative projects from across the country, demonstrating how local organisations are implementing the national maternity review’s recommendations and giving women greater control and more choice. As local areas take forward the vision set out in the review, listening to and acting on user feedback should be high up their agenda.
And as Sarah-Jane Marsh, Chair of the Maternity Transformation Programme Board, has said in response to our report: ‘True transformation of maternity services can only be done by listening to women and families, and understanding their experiences.’