Case study: Luton and Dunstable Hospital                        DVD also on NHS Institute website   Printable information ...
How they did it     “Like all hospitals, we were concerned by the rising        Midwife Heidi Beddall trained within a low...
Luton and Dunstable has been careful to ensure that its      and her team. “My first baby was 9lb 11oz andphilosophy on no...
Local results     Impact on quality of care                                  Return on investment calculation     80% of t...
Key themes and methodologyLearning from human factors                                 Some of the common human factors tha...
“Human factors are all the things that       “We have introduced a daily      make us different from logical, completely  ...
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Luton and Dunstable Hospital


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Luton and Dunstable Hospital reduced their C/S rate from 31% (April 09) to 22% (2010), this extract frrom "Promoting Normal Birth" says how they managed to do this in a year!

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Luton and Dunstable Hospital

  1. 1. Case study: Luton and Dunstable Hospital DVD also on NHS Institute website Printable information from the NHS Institute websiteTop to bottom culture change deliversoutstanding resultsWhen c-section rates peaked at 31% in April 2009,it was a wake-up call for Luton and Dunstable “Luton is a deprived area and weHospital’s maternity department. A year later, rates had lost our focus on normalare averaging around 22% – well below thenational average. The hospital has achieved this birth due to the large numbers ofthrough top to bottom cultural change and a high risk women coming ontocommitment to normalising births. the unit. Since 2009, we haveSetting the scene succeeded in turning thatThe trust has approximately 5,500 babies born each around with a change in cultureyear and had a c-section rate of 31% in April 2009. towards making birth a normalThe approach experience. Women now remainThe trust introduced a midwife lead for normality, under the care of a midwifeto champion normal birth with staff and pregnantwomen and developed a birth option clinic for women throughout their pregnancywho had previously had a c-section. unless there is a good reason toNormality study days were designed for community do otherwise.”staff and ‘skills books’ created for maternity care Katie Chiltonassistants which detailed training and competencies Delivery suite matronfor each individual. 11
  2. 2. How they did it “Like all hospitals, we were concerned by the rising Midwife Heidi Beddall trained within a low risk unit c-section rate,” says head of midwifery, Helen Lucas. and joined Luton and Dunstable to gain experience of “We are a level three neonatal unit and there was working in a high-risk environment. When the post of generally a perception among staff that this made midwife lead for normality came up, she was keen to us a ‘high risk’ unit. In 2008, we started using the go back to her roots and pursue her passion for maternity dashboard to give us a month-by-month normal birth. She has been instrumental in introducing picture of the number of c-sections taking place. a range of training and support initiatives, including a The following year, we employed a midwife to lead birth options clinic for women who are requesting a on the normalising agenda. Since that time, there has c-section after a previous section or a traumatic birth been a drive to change attitudes and behaviours. experience. “Women come along to the clinic after We are now seeing c-section rates coming down and they have seen the consultant if they are requesting a normal deliveries, particularly VBAC (vaginal birth after c-section,” says Heidi. “We discuss all of the issues and Caesarean) rising significantly. talk about the physical, social and emotional impact of different birth choices. Even if women don’t ultimately “We have introduced a daily multidisciplinary review choose a VBAC, I want them to feel fully debriefed and meeting to look at all of the deliveries over the counselled before they make their birth plan.” preceding 24 hours and staff at every level are encouraged and empowered to speak out and While it is impossible to measure the impact of this give their opinion – even challenge senior staff,” work on every woman’s experience, feedback has she continues. been extremely positive. In a recent audit, 80% of women who had spoken to Heidi or Bright about their Consultant and lead obstetrician, Bright Gympoh, birth choices went on to attempt a VBAC and around has acted as a champion for the normalising births half were successful. agenda. He believes this is the key to achieving organisational change. Bright comes from Ghana, where Caesarean sections are rare and he was disturbed by the rising rate of c-sections when he joined the hospital 12 months ago. “My advice to anyone embarking on this type of work is to get a midwife who is keen on normal births together with an equally keen consultant and leave them to drive any changes,” he says.12
  3. 3. Luton and Dunstable has been careful to ensure that its and her team. “My first baby was 9lb 11oz andphilosophy on normalising birth extends to every staff was delivered by emergency Caesarean,” she says.level. Training is provided for maternity care assistants, “I assumed my next baby would be big and I didn’tcoordinated by senior midwife, Karen Billington. “We think I could have a natural birth. Heidi said she couldwant maternity care assistants (MCAs) to feel part of the coach me and I kept in contact with her throughout myteam and to be involved in discussions about normalising pregnancy. She even came with me to see thebirth,” she says. “MCAs are the first point of contact for consultant. She showed me how to get the baby intowomen coming onto the unit and they set up the rooms the right position, how to cope with the contractionsfor birth, so it is important that they understand the and what positions would help me to have a normalimpact of the birth environment on outcomes and are delivery. Robert came within 50 minutes. It was a goodfully on board with the idea of normalising birth. As well experience. I wanted to have a natural birth for theas training MCAs on how they can help women to have health of the baby and I was home the same afternoon.a normal birth, we make sure they understand the The baby was relaxed because I was relaxed.”nature of emergencies so they can respond appropriately More improvements are planned, including a pre-birthwhen a situation is urgent. Now, when we receive thank clinic, which will advise women on the process of earlyyou cards they often mention the MCA by name and labour and provide information on self-care. In Maythank her for the care she gave.” 2010, a new midwifery-led birthing unit will open,All maternity care assistants are given information providing four ensuite rooms and a birth environmentcards when they join the hospital explaining geared towards normalising birth.terminology and providing a list of key contacts and “This is what midwifery is all about,” says Helen.telephone numbers. Karen introduced the concept “Giving birth is natural.”of skills books for maternity care assistants fromelsewhere in the hospital. The books provide detail e built a “I am proud of the fact that we hav kingon training and competencies for each individual. fantastic team and everyone is wor a year ago.Community midwives are also regarded as crucial together much better than they did andto promoting normal births and can now attend We have successfully implemented maintained the daily review meeting and wenormality study days, held on Saturdays. “Normality ic, whichstarts in the community,” says Helen. “It’s important now run a regular birth options clin natal care.that community midwives feel supported.” will soon be expanded to cover pre- It has been absolutely fantastic – this is aNew mum Charlotte Barnett recently had a successful great place to work.”VBAC, thanks to the support she received from Heidi Bright Gympoh Consultant and lead obstetrician 13
  4. 4. Local results Impact on quality of care Return on investment calculation 80% of the women who attend the birth options Costs of the following inputs were calculated for clinic to discuss their birth choices went on to attempt the project: staffing for the birth options clinic; daily a VBAC and around half were successful. case note review sessions; and normality study days. The unit plans now to open a pre-birth clinic, Impact costs were calculated in terms of money saved designed to advise women on the process of early as a result of more babies being delivered by normal labour and encourage self-care. birth rather than by Caesarean section. For every £1 spent Luton and Dunstable generated £1.11 of Impact on patient experience benefits over a year. This calculation does not take into Women now have a wider range of options and more account the additional quality benefits that have not information to make a choice that is right for them. been monetised including mothers’ increased They also have greater opportunity to discuss their satisfaction with care nor any additional costs incurred concerns with staff. in community midwifery. Impact on staff experience The trust focused on improving staff skills through Further information available from the NHS Institute website targeted training programmes, including normality study days for community midwives, which are held on Saturdays to improve access. In addition, all maternity care assistants are given information cards explaining terminology and providing a list of key contacts and telephone numbers. Skills books provide details on training and competencies for each individual.14
  5. 5. Key themes and methodologyLearning from human factors Some of the common human factors that can increaseLuton and Dunstable hospital has introduced learning risk include:from human factors as part of the drive towards safer • mental workloadbirthing and promoting normality. This approach • distractionsrecognises that the majority of substandard care can • the physical environmentbe attributed to human factors. The trust uses a rangeof communication tools, particularly SBAR (situation- • physical demandsbackground-assessment-recommendation), to ensure • device/product designthat everyone on the team feels able to speak out in • teamworkthe interests of patient safety. Work at the trust • process design.focusing on human factors is in its infancy but isalready contributing towards a change in culture. Find out more from the NHS Institute’s Safer Care web pages: factors encompass all those factors that can general/human_factors.html or the Patient Safety Firstinfluence people and their behaviour. In a work website: they are the factors relating to the work .aspx?path=/interventions/additionalguidence/humanenvironment, the job itself and the organisation and factors/the individual characteristics which influence people’sbehaviour at work. Download the ‘How to’ Guide for Implementing Human Factors in Healthcare: http://www.patientHealthcare professionals are human beings and, like all beings, are fallible. In our personal and working -support/Human%20Factors%20How-to%20Guidelives we all make mistakes in the things we do, or forget %20v1.2.pdfto do, but the impact of these is often non-existent,minor or merely creates inconvenience. However, in Visit the NHS Institute or Patient Safety First websites forhealthcare there is always the possibility that the a video of a story which illustrates human factors issues.consequences could be catastrophic. It is this awareness In ‘Just a Routine Operation’, Martin Bromiley, an airlinethat often prevents incidents as we purposefully pilot, discusses his personal experience of healthcare.heighten our attention and vigilance when weencounter situations or tasks we perceive to be risky. Further information available Other sources of information from the NHS Institute website 15
  6. 6. “Human factors are all the things that “We have introduced a daily make us different from logical, completely multidisciplinary review meeting to look predictable machines. How we think and at all of the deliveries over the relate to other people, equipment and preceding 24 hours. Initially, the idea was our environment. It is about how we greeted with some scepticism as people perform in our roles and how we can expected it to be all about blame, but we optimise that performance to improve use a human factors approach to say safety and efficiency. In simple terms it’s ‘what did we do well?’, ‘what could we the things that affect our personal have done better?’ and ‘if we encounter performance.” this situation again, what would we do differently?’ Staff feel empowered and Clinical Human Factors Group (CHFG) happy to come to the meetings. The hierarchy has diminished and junior staff are happy to liaise with senior colleagues. I was delighted when a junior colleague spoke out and corrected me recently. We are also using human factors to interpret CTGs in a more uniform way.” Bright Gympoh Consultant and lead obstetrician16