Heartbeat: A safe and sustainable infrastructure within community midwifery

April 14, 2022

By Randeep Kaur, Clinical Lead Midwife for Transformation

Delivering a service that meets national and local standards and takes in to consideration our diverse and often deprived population is a challenge, but one that we are now on the path to address so that we can ensure all of our women receive the care they need. We know mortality rates remain higher for babies of Asian and black ethnicity, stillbirth rates are over twice those for babies of white ethnicity and neonatal mortality rates are 45-60 per cent higher than for babies of white ethnicity.

National reports including the NHS Long Term Plan 2019 and Better Births 2020 have for a long time advocated improvements across all maternity services.

At SWB we started our process of transformation and innovation in January 2021. We analysed the feedback we regularly receive from patients and staff and put in place plans to address the common issues that have been raised about our services. Learning is an important factor to support our improvement journey. How were we learning from incidents? What could we do about missed care and missed opportunities?

There was a need to take immediate action to improve outcomes to support the Best Start in Life agenda (2021). To take this agenda forward, our staff and their wellbeing was placed at the heart of everything we do, so we put in place mechanisms for feedback such as surveys open door sessions.

As a result,15 priorities were identified and a process put in place to tackle each priority using the Quality Service Improvements and Redesign (QSIR) tools and framework.

What’s gone well: Transformation continues to set the foundations for long term sustainable change and improvement. Work to date includes building governance structures and devising specific assurance tools to improve the safety and quality of our maternity care. Assurance tools include Use of digital calendars, Electronic allocation of work, Implementation of daily duty midwife, Monthly record keeping audit, AN Booking Tracker, Caseload data submissions, Assurance meetings and x3 weekly with head of midwifery. Governance in regards to regular meetings within all management structures have been reviewed and introduced where required to support assurances from ‘floor to board and board to floor’.

What to work on: Ongoing review of assurance tools by managers and staff at all levels to ensure processes are enacted so there is continuous improvement, development of a safety and civility culture by embedding a sense of shared ownership/responsibility and accountability. Refined community provision in regards to we need to ensure ‘we get it right’, for both the population we serve and our staff. The team leaders have supported the initial scoping for this new provision and identified the following key changes and work is well under way; Early Bird Clinics prior to booking, Out of area bookings, new enhanced and efficient ways of working, Making every contact count and Bespoke Caseload Tool specific to SWB to enhance Birth Rate Plus.

Where we want to be: Deliver ‘high quality care’ that is Safe, Effective, Timely, Efficient, Equitable and People-centred to ensure we meet the needs of our community we serve for the Best Start in Life (2021) and beyond here at SWB.

I want to thank all colleagues for their valued contributions to date. We must continue this journey together as we have a long way to go. Improvements and transformation are everybody’s business.

The impartiality and support afforded to transform roles has enabled colleagues to challenge leaders and stakeholders at every level to improve outcomes for the babies, women and families we serve.

Our transformation and improvement outputs have generated interest and will be presented at the Maternity Festival to be held in Birmingham later this year.