James Boyes - ECO14: Patient Safety
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Presentation by Dr James Boyes, Quality Improvement Programme Manager, NWC SCN at ECO 14 in Preston - "Maternal and neonatal health safety collaborative"
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James Boyes - ECO14: Patient Safety
- 1. Maternal and neonatal health safety collaborative Dr James Boyes Quality Improvement Programme Manager NW Coast Strategic Clinical Network December 2017
- 2. 2016 Better Births report published - Improve choice - Personalise maternity care - Improve safety
- 5. - Mothers & Babies: Reducing Risk through Audits & Confidential Enquires (2012) - Each Baby Counts (2015) - Better Births (2016) - Sign up to Safety: Spotlight on Maternity (2016) - Safer Maternity Care (2016) - Saving Babies Lives Care Bundle (2016) - Avoiding Term Admissions into Neonatal Units (ATAIN) (2016) - Implementing Better Births: A Resource Pack (2017) - Perinatal Mortality Review Tool (2017) - Getting it Right First Time (2017) - Maternity Safety Strategy (HSIB) (2017)
- 6. Local Maternity Systems & the NW Coast SCN • Reduce variation to improve clinical outcomes • 2 STPs within the region • 13 Providers (9 + 4) • Regional Clinical Experts Group • Various Special Interest Groups • Safety Collaborative
- 7. Key Themes • Learn from incidents & share that learning effectively • Work collaboratively • Reduce variation • Measure what we do (data and dashboards) • Evidence based improvement • Change culture & workforce
- 8. How is the collaborative structured? 8 National Learning Set (Trust Improvement) Trust Trust Trust Trust Trust Trust Trust Local Community of Practice (System Improvement) NWC SCN Safety SIG TrustTrust Trust Trust SCN / LMS
- 9. … the Secretary of State announced a national ambition to halve the rates of stillbirths, neonatal and maternal deaths and intrapartum brain injuries by 2030, with a 20% reduction by 2020 Saving Babies Lives Care Bundle (2016) NW 4.85 NW 4.55
- 10. Cheshire and Merseyside SATOD (Wirral JSNA, 2015)
- 11. Smoking Cessation • 10.5% nationally 16/17 • 6% national target set (07/17) • Blackpool @ 25% SATOD • Trend is a reduction in rates but NWC still significantly higher than the national average • Population & depravation • Public Health & inter- agency working • Resources & support • Roles & responsibilities of each partner within this initiative?
Editor's Notes
- If James presenting, explain that David sends his apologies due to illness. Outline purpose of the presentation is to outline the landscape and broad agenda for safety within the context of maternity services.
- Key document underpinning the national transformation of maternity services is Better Births. Published last year and calls for significant changes to what services are delivered as well as the ways in which those services are delivered. Those intending to work within improvement within maternity and perinatal mental health services are well advised to familiarise themselves with this document. 2021 & obligations for Providers
- Briefly explain the key areas from BB Patient choice Personalisation of services Safety This slide covers choice and personalisation. Without informed choices being made available to you can’t readily personalise. Not every region or area has Providers offering all choices to women. Broad point, most women deliver in an obs. unit but only 25% of women surveyed as part of BB said that’s what they wanted.
- Safety is a key element of BB any while giving birth within the UK is safer than it is elsewhere in the world we do not lead when it comes to the provision of safe services. Globally 18.4 stillbirths per 1000 births (Lancet & WHO) in 2015, Pakistan had the world’s highest rate at 43.1 per 1000 with Britain being 24th out of 49 high income countries. Croatia, Poland and Czech Republic all have better stillbirth rates than UK (Tommys). Not only is there a high financial cost associated with this outcome (£564 for every birth spent meeting compensation claims) the human cost is also significant. And unlike many other areas of healthcare, the cost is borne for a lifetime when we consider avoidable birth injuries. Hence safety is a key driver for maternity services and systems with many complimentary initiatives now underway
- Brief run through. Note that they stretch back to 2012. Comment that the Kirkup report not mentioned here but acknowledge that it is a key driver of the need for Better Births. Comment that all of these initiatives are safety focussed and see managed QI as the vehicle through which improvements to services should be delivered at the systems level. Within the North West Coast that activity is managed ….
- For the North West Coast the SCN works within that broad remit. Complex as there are 13 Providers, 2 STP’s and 2 Local Maternity Systems. We also have a mix of Vanguard, Early Adopter and Pioneer programmes underway at different places within NWC. Yet at the same time we have a regional CEG alongside established SIGs. Those SIGs satisfy the need for the regional Safety Collaborative Community of Practice and offer another vehicle through which we build relationships between Providers and Agencies to better improve services and support national initiatives and targets.
- So as we’ve seen there are a number of initiatives all considering safety. It is clearly a complicated landscape. However, there are key themes that emerge. Collectively, our services need to improve the ways in which they learn from incidents. We need to move away from a culture that focus’s upon apportioning blame, to one in which the route causes of an incident are explored so that they are irradiated in the future. Doing so will require collaboration beyond professional and organisational boundaries along with a greater understanding of improvement methodologies and tools. Likewise, we lack data. In the North West Coast we’ve developed a leading maternity data dashboard and data set but this isn’t the case nationally. QI and safety improvement relies upon timely, accurate, complete and pertinent data being available and this presents an enormous challenge given the complexity of Providers and systems in use. Fetal monitoring in labour Raising awareness of reduced fetal movements Improving care for babies who are small for gestational age Understanding working cultures in maternity providers and how this impacts care Improving processes for sharing learning when things do not go as planned Rapid redress schemes & involvement of the parents/family within the process Smoking cessation Outcome dashboards Shared maternity records & the use of apps Continuity of Carer and changes to the relationship between the health care professionals, system and woman/family Improving choice and accessibility of care for service users. And what all of this leads to is the need for evidence based improvement and systemic changes such that variation is services is eliminated and outcomes are permanently improved.
- The safety collaborative is a national DoH initiative to drive forward maternity QI initiatives. This includes improvements within providers and also requires providers to work together as communities of practice. Our community of practice operates with the SCN, the Innovation Agency, NHS Improvement and the Local Maternity Systems linking Trusts together at the local level in order to deliver sustainable and replicable change.
- For example, Stillbirth and the reduction of stillbirth is a key deliverable across the initiatives we’ve already looked at. What we see is a gradual reduction in stillbirth rates. But as we’ve already seen we are somewhere in the middle when it comes to the developed nations hence there is still an ambition to further improve. Now one of the well recognised contributory factors to stillbirth is smoking during pregnancy. It is estimated that smoking in pregnancy is a contributory factor in up to 14% of stillbirths and smoking is one of very few truly modifiable risk factors. We’ve chosen this work to talk through because it demonstrates the complexity and ‘systems approach’ that is needed to now deliver further improvements. Crucially, without those improvements the greater goal of stillbirth reduction becomes questionable.
- Here are the figures for Cheshire & Merseyside through to 2016. You can see that the rate of Smoking at Time of Delivery has consistently and significantly decreased over the last 5 years. However, despite the efforts of the Trusts involved, we are still higher than the national average (about 10.5% last year) and the relative position of our Providers hasn’t changed – they’ve all reduced but their relative performance remains unchanged.
- Hence the challenge now is to understand why this pattern remains. It is only when we understand the underlying causes, and their impact upon elements of the safety agenda that we will be able to deliver across the board improvement. As we said, this issue epitomises the challenges that we face with the safety agenda – smoking doesn’t exist in a vacuum; social depravation and population characteristics play a huge role. Similarly, as tempting as a blanket target can be this can further complicate the process; Blackpool have made huge improvements but a target of 6% is highly questionable. At the same time, we have parts of Cheshire now running at less than 5% hence should they be encouraging women to start smoking? All joking aside, I hope this helps you to understand some of the complexities and challenges now facing those us working within maternity services and their improvement. And despite those challenges what is clear is that delivering the improvements being called for is now a national priority across the NHS.