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North West Coast Maternity and Neonatal Learning System

The document outlines the development and implementation of the North West Coast Maternity and Neonatal Learning System, emphasizing improvements in maternity and neonatal care across Cheshire and Merseyside. Key focus areas include patient safety, workforce development, and enhanced access to care, as well as collaborative efforts among various NHS organizations to create new care models and standards. The initiative aims to address existing variability in care quality and outcomes for women and children, ultimately striving for a safer and more efficient healthcare system.

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North West Coast Maternity and Neonatal Learning System
The Birth and Evolution of Improving me Catherine McClennan Programme Director
It started with clinical outcomes……
0 2 4 6 8 10 12 14 16 18 20 Liverpool W. Cheshire Warrington Halton Wirral Southport and Formby St Helens West Lancashire South Sefton Knowsley National Average Smoking at time of Delivery % 50.9 68.2 60.7 52.3 56.7 54 52.3 40.8 73.9 29.1 39.3 34.2 22.1 31 27.5 22.1 17.5 47.2 0 10 20 30 40 50 60 70 80 Liverpool W. Cheshire Warrington Halton Wirral Sefton St Helens West Lancashire Knowsley National Average Breastfeeding Rates % 20% of women develop mental health problem in pregnancy Less than 50% formally diagnosed 10% Dads suffer too Costs UK £8.1b per annum Estimates 5 x cost of improving services 63,311 59,714 38,862 23,939 28,680 106,084 46,084 32,459 56,438 19,609 Cheshire East Cheshire West and Chester Warrington Halton Knowsley Liverpool Sefton St.Helens Wirral West Lancs Women of Childbearing Age 2015 ……..and population data
We spoke to Women & Families
We created Improving me WOMEN BABIES MEN FAMILIES COMMUNITIES WORKFORCE To deliver excellent experiences for women, babies and their families To offer informed choices and care closer to home To reduce variation across services and improve outcomes To provide safe, high quality, equitable services
Maternity Gynaecology Neonatal Paediatric Cheshire and Merseyside Women's and Children's Partnership Clinical and Operational Networks Clinical Commissioning Groups Providers People • Acute Care Collaboration Vanguard. • Only Vanguard with exclusive focus on women’s and children’s services. • Formation of Cheshire and Merseyside Women’s and Children’s Services Partnership. • 27 NHS Organisations working together to develop New Models of Care. • Opportunity to do things differently. We formed a Partnership
We rallied the troops  Appointed Clinical and Nurse leads  Created and utilised clinical networks  Provided summits to voice concerns, share ideas and co-design  Became a partnership  Developed robust governance framework  Became a system with a vision, a mission & values  We collaborated and broke down barriers  We involved people
We dealt with……
We developed a case for change “Staffing ‘inadequate’ at baby death hospital“ (BBC, 2017) “Hospitals forced to suspend acute services due to lack of doctors and nurses” (ITV, 2016) “Family in line for massive NHS pay out after baby suffered brain damage during birth” (Liverpool Echo, 2017) “NHS suffering 'virtual storm' of financial pressures” (BBC, 2017) The key messages are: Patient safety is being compromised by workforce shortages, resulting in sub-optimal clinical outcomes. Access to care outside of a hospital setting is limited with patients receiving insufficient choice. Services are not financially sustainable in their current form. Cheshire and Merseyside Delivering the Five Year Forward View 29% of Obstetric & Gynaecology medical roles and 22% of Paediatric medical roles were vacant in November 2016 30% variation in the proportion of pre- labour caesarean sections performed before 39 weeks of gestation without clinical indication as one example of outcome variation 3/8providers do not offer alongside-midwife led provision while there are no free- standing midwife- led units. Home birth rates are half the national average 0/8 providers are fully compliant with BAPM standards for medical and nursing staff 0/8 providers are fully complaint with the RCPCH Facing the Future standards (SCN audit, 2016) 6/8obstetric units across Cheshire & Merseyside are classified as “small” given they have annual birthing figures of less than 3,500 births >10% the standardised and adjusted neonatal mortality rate – an adverse outlier when compared to the UK average 68% of all A&E attendances result in discharge without significant treatment or follow-up treatment by a GP Source: Commissioner SUS Data (2015/16) Source: Neonatal Data Analysis Unit (2015) Source: NWNODN (2017) Source: RCOG (2016) Source: NHS Digital Source: Provider Data Returns In Cheshire & Merseyside: 1 2 3 Source: HEE
We went on a journey….  ‘The lord giveth and the lord taketh away’ (Job1:21)  ‘Say hello and wave goodbye’  We grew and evolved  We put women and children first  We included men and the workforce and partners and friends  We created hope and a belief that change would come  That it was positive and needed  That this time it would happen
Partnerships Clinical Delivery Networks Cross-Cutting theme of STP Maternity Pioneer Maternity Early Adopter Clinical Summits Consensus for new models of care We Collaborated for Change
We created a template for new models of care
We embraced Better Births Consistent principles nationally, with flexibility to implement locally
 Workforce Lead  Cheshire and Merseyside Collaborative Advanced Paediatric Nurse Practitioner Programme and the creation of Advance  Cross-provider training in Hypno-birthing  Maternity Support Workers working in community to support BB Community and Health Improvement  COM-B programme completed by Bridgewater community midwifery team  Paediatric support for Primary Care  Midwifery Conference – ‘Caring for You’ October 2017  Shared Services and Shared teams developing  Provider Road shows  Royal Colleges engaged  Cheshire and Merseyside approach to vacancy, recruitment and retention issues  Central to redesign of New Models of Care We respected our workforce
We ensured we are part of the future
We Met Brave People Along the Way
We seized the opportunity to do things differently  The Brink  The Female mind  Game Changer  Baby Boxes  Advance  Pop-Up MLUs  Social prescribing  Neomates  PMCBs  Innovation and Technology
We ensured that ‘we are family’
And we achieved…..  Case for Change  Baseline outcomes mapped by providers  Clinical Delivery Networks established and Meet regularly  W&C data collection  Redesign workshops held for Gynaecology, Maternity, Neonatology & Paediatrics  Workforce Strategy  Communication Strategy  Option Appraisal Process commenced  Review of Neonatal Intensive Care Services complete
Our Achievements  Paediatric Primary & Secondary Interface Group  Joint approach to Public Health o Smoking o Pertussis vaccination rates improved o Maternal Flu Improvement Plan o Health improvement  Health as a social movement  Neonatal Activity, Capacity, Demand and Cot requirement review  Neonatal surgical pathway review and options appraisal  Integrated Palliative Care Pathway  C&M midwifery strategy
Our Achievements  Positive engagement with family groups  Launch of C&M Maternity Voices  Innovation and Technology  Development of a New Care Models product library  Delivered Neonatology ICU option appraisal recommendations  Working with the Innovation Agency to create a Maternity Cluster  Pop Up MLU opening at Seacombe Children’s Centre  Evaluation Focus Groups held and more in progress  Working collaboratively with Walton Vanguard  Clinical Scenarios developed for consultation  New Models created and shift to community hub delivery model  Clinical Summits held  Partnership with Libraries and Museums as part of cultural manifesto  Roll out of 30,000 Baby Boxes
Our Achievements  Social Prescribing Platform  Neonatal procurement consortium created  Continuity of carer audit undertaken and teams identified  Delivered draft blueprint to C&M system leaders  Clinical Advisory Group  Key work stream for STP
BetterHealth •Improving Outcomes •Reducing Variation •Standardised Pathways •Quality Dashboards •Prevention •Public Health •Community engagement •Health as a social movement •Education •Family Focus •Integrated care •Population Health •Self Care BetterCare • Improved Quality • Care Closer to home • Patient focus • Consistency of Approach • Single Point of Access • Less confusion • Standardised pathways of care • Workforce support • New Roles • CQC outcomes • Safety Collaborative • Reduced separation • Electronic records • Clinical Networks • MDT • Shared services • Cross-provider & lead provider models BetterValue • Right care, right place, right professional • Consistency • Shared pathways • Reduced repetition • Joint services • Reduction in complaints • Reduction in CNST • System delivery • Network procurement • New pricing models • Lead provider • IMT & Innovation • Workforce used in different way • Social Value • New partnerships • Speciality Provision • Redesign of service delivery points We will deliver Our ambition!
Be brave, be bold……. but above all else do something.
The Journey so Far Vanessa Wilson 5th June 2018
 Who? – Everyone  Why? – Improve safety and reduce variation in care – Efficiencies and enhanced effectiveness – Make services more accessible and give women and families choice  When? – By 2021 Local Maternity System27
 Population of 1.7 million (GP registration)  Population of 1.18 million (Based on residency)  Covering 3500 square miles (9065 sq kms)  Diverse populations, complexity & consanguinity  Geographically varied from rural to cities  Areas of high deprivation and health needs Context28
Providers29 • 5 x providers of maternity services • 10 x settings + Home Births • Circa 17,500 births per year • Bay – 3080 • Pennine – 6700 • Central – 4400 • Blackpool – 3300 • 2 x L3 Neonatal Units
Programme Management30 Project Lead and SRO since October 2017 Secondment in ICS January 2018 for 12months Project Management Team recruited –2 x Project Managers –Family Engagement Coordinator –Admin and Project Support ‘adopted’ SCN maternity team - safety and peri- natal MH Now getting organised!
Planning and Milestones31 • Transformation plan submitted and resubmitted • Trajectories established and agreed for • Number of women birthing in a low risk, midwifery led setting • Number of women being offered continuity of carer • Number of women with a Personalised Care Plan • Number of women given full choice of birth setting • Implementation Phase
Governance Arrangements32
 Out of Hospital / Community Hubs  Post Natal Care  Continuity of Carer / Workforce Development  Choice and Personalisation  Digital  Safety (SCN Safety SiG)  Neonatlogy (NWC ODN)  Perinatal Mental Health 8 Work Streams33
34 • Work Force Scoping • Links established with Maternity Voices Partnerships • Communications Plan developed • Transformation Funding secured • NHS Resolution Incentive Scheme
 Geography  Culture change required  System vs Silo  Competing priorities for organisations and individuals Key Challenges35
 Review and revise governance arrangements and Terms of Reference to allow for delegated decision making  Increase profile of BB L&SC  Engagement events re CoC  Infant feeding Strategy Next Steps36
Assembly Meeting 22nd June – Gujarati Centre Preston  Please Come! https://www.eventbrite.co.uk/e/local-maternity- system-assembly-meeting-tickets-45721569445 Contact: vanessa.wilson6@nhs.net Contact Points and Details37
Thank You for Listening 38
North West Coast Maternity and Neonatal Learning System Integrated working David Rowlands Clinical Lead for Maternity NW Coast Strategic Clinical Network June 2018
Local Maternity Systems across NW Coast SCN • 2 LMS within the region – SCumbria & Lancs – Cheshire & Merseyside Vanessa Wilson Simon Banks
Evolution • 7/13 – Maternity Children & Young People – became one of 5 statutory SCNs • 9/13 – Stakeholder group – Perinatal mental health – Standardising care in complex conditions – Pre term birth – Stillbirth – Reducing variation
Perinatal Mental Health • Chair:Tania Stanaway now Gillian Strachan – Standardised pathway for depression – Increased community perinatal mental health provision – New mother and baby unit in NW Coast footprint – Asking the right questions at the right time – Parity of esteem
Complex conditions • Chair: Helen Scholefield – Cardiac pathway – Critical care pathway – Diagnostics for placenta accreta / percreta – Thyroid disease guidelines – Diabetes (linking with diabetes network) – Hypertension – Renal – HIV – Morbid obesity
Pathways of Care Maternity Clinical Experts Group (inclusive of all providers; NWAS; safety collaborative, LMS, neonatal ODN etc) – Complexity guideline – emphasis on normalisation – Pre- eclampsia – Post partum haemorrhage – Sepsis – Prematurity
Preterm labour • Chair: Sara Brigham – Standardised pathway for diagnosis & management of preterm labour including IUT – Emphasises multidisciplinary working; multiple providers including NWAS
Reducing Variation Clinical Dashboard • Co- chairs – Simon Banks /David Rowlands RCOG Patterns of Maternity Care Clinical quality & safety Patient experience and choice Safeguarding
NW Coast Dashboard National dashboard 14 measures Front sheets reflecting national agenda – CNST 10; 2020 targets Phase One (Defined Metric Numbers) Phase Two (Provisional Metric Numbers) All Phases (Provisional Metric Numbers) Provider Submitted Metrics 74 63 137 Aggregated Metrics 101 59 160 Total Metrics 175 122 297
Benefits • Standardise measures • Data accuracy • Mirror on what you are doing • Refection of what others are doing • Assurance tool • Early warning system • Service improvement tool
Stillbirth SIG Chair SCumb & Lancs: Liz Martindale Chair C&M: Devender Roberts now Alice Bird – Stillbirth bundle – Grow charts – Each Baby counts – External attendance at RCA for stillbirth – Sharing lessons learned – Assuring implementation – Multiagency working
Stillbirth rate
• About average • But a bit higher than average • This equated to 8 more babies lost per year • We weren't and aren't happy with being average • We want to be the best!
Stillbirth rate
333 18 fewer than E&W average >25% reduction 36 fewer stillbirths
Safety SIG • Chair S Cumbria & Lancs: David Burch • Co-Chairs C&M: Kate Alldred/Lynda Coughlin • Mandy Townsend – Dashboard review – Lessons learned – Maternity & Neonatal Health Safety Collaborative • Maximise benefits • Shared learning (not waiting for 3 waves) – HSIB
Maternal and neonatal health safety collaborative Dec 2016 • to reduce the rates of maternal deaths, stillbirths, neonatal deaths and brain injuries that occur during or soon after birth by 20% by 2020 and 50% by 2030. 2025 • reducing national rate of pre-term births from 8% to 6% 2025 Will help all maternity care providers and commissioners to: • improve clinical practices • reduce unwarranted variation • report on how they are contributing to achieving the national ambition • 3 year programme - ongoing
Opportunity • Fantastic to have so much focus on Maternity • Maximise the benefits through integration • We are a true network – a Partnership • The strength of the network is its membership • Variation still exists • Come a long way • Long way to go • HSIB/ Better Births/ CNST 10/ RCOG Each Baby Counts/ Board Safety Champions
Thought for the day
Nicky Lyon’s challenge Campaign for safer births (NHSI website) • How do you know your unit is delivering the safest care possible? How does your unit compare to others in the MBRRACE audit & National Maternity & Perinatal Audit data? • Is your unit following all current guidelines? Are they documented, trained, audited? • Are you investigating all Serious Incidents robustly with external representation and parental input invited? How are you supporting the staff in the unit to implement recommendations from these reviews? • Do you know how many stillbirths there have been in your unit? Do you know how many occurred during labour? How many Serious Incidents?
• Do you read feedback and comments from parents in the Friends & Family Test and the Care Quality Commission questionnaire? What changes have you implemented in response to this feedback? • Have you checked the staff in the unit are receiving all the training, support and resources they need to do their job well? • Is multidisciplinary working developed at your trust – with joint training, briefings and handovers? • Have you briefed the board on maternity safety and the activity you would like to undertake to further improve? https://improvement.nhs.uk/resources/parents-view-my- challenge-board-level-maternity-safety-champions/
It is amazing what you can accomplish if you do not care who gets the credit Harry S Truman By working together we can accomplish great things. Because it is the right thing to do.
Maternity and Neonatal Safety Collaborative Safety is the state of being "safe", the condition of being protected from harm or other non-desirable outcomes Julie McCabe Network Director RGN RM BA MSc
Neonatal Work Programme Better Health Improving Outcomes • Family integrated care • Reducing the number of babies separated from their mothers • Optimising Place of delivery • Network approach to the reduction in neonatal mortality • Workforce development Better care Improving Quality • Cardiac pathway • Integrated palliative care • Surgical pathway • Single neonatal surgical service • Neonatal outreach CQUIN • Network education and training • Workforce development Better value Right care, right place, right professional • Activity Capacity Demand review • Central capacity cot/bed management system • Network procurement • New Pricing and contracting models • Workforce planning
Quality Improvements  NWNODN quality improvement programme  Maternity and Neonatal Transformation – local Maternity Systems  Better births implementation plan  Maternity and Neonatal Health Safety collaborative  Support maternal and neonatal care services to provide a safe, reliable and quality healthcare experience to all women, babies and families across maternity care settings in England  Create the conditions for continuous improvement, a safety culture and a national maternal and neonatal learning system.  Contribute to the national ambition of reducing the rates of maternal and neonatal deaths, stillbirths, and brain injuries that occur during or soon after birth by 20% by 2020.
Births Code Cheshire and Merseyside Neonatal Network 28,573 ● Lancashire and South Cumbria Neonatal Network 16,986 ● Greater Manchester Neonatal Network 37,215 ● ● up to 10% higher than the average for the comparator group ● more than 10% higher than the average for the comparator group Neonatal Mortality EMBRRACE 2017
5 key Clinical Interventions 1. Improve the proportion of smoke free pregnancies 2. Improve the optimisation and stabilisation of the very preterm infant 3. Improve the detection and management of diabetes and management of diabetes in pregnancy 4. Improve the detection and management of neonatal hypoglycaemia 5. Improve the early recognition and management of deterioration of either mother or baby during or soon after birth
Improve the proportion of smoke free pregnancies
Improve the proportion of smoke free pregnancies
Improve the optimisation and stabilisation of the very preterm infant <27 Week First Admissions Apr 16 – Mar 17 IC % NICUs 2015/16 2016/17 Greater Manchester 89% 90% Cheshire & Merseyside 73% 83% Lancashire & South Cumbria 89% 91%
Optimising Outcomes Administration of steroids 24- 34/40 2015-2017 Eligible Mothers Steroids given (%) (N: National % ) Not given Missing/Unknown 2015 2439 2098 (84%) (N: 85%) 330 9 2016 2353 2011 (85%) (N: 85%) 299 43 2017 2318 2017 (87%) (N: 82.6) 223 78 Administration of Magnesium Sulphate < 30/40 2016 -2017 Eligible Mothers Magnesium Sulphate Given(%) (N: National % ) Not given Missing/Unknown 2016 586 205 (35%) (N: 39%) 188 193 2017 532 321 (60%) (N: 57.4%) 140 71 PReCePT: Reducing cerebral palsy through improving uptake of magnesium sulphate in preterm deliveries
Improve the detection and management of diabetes in pregnancy
Improve the detection and management of neonatal hypoglycaemia Term admissions by unit as % of total births 2.70% 11.30% 0.00% 2.00% 4.00% 6.00% 8.00% 10.00% 12.00% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 L&SC GM&EC C&M
Top 5 reasons for Admission Lancashire and South Cumbria Greater Manchester & East Cheshire 36% 18% 13% 7% 4% 22% Respiratory disease Infection suspected / confirmed Hypoglycaemia Poor condition at birth Monitoring (short observation) Other 38% 11%9% 6% 4% 32% Respiratory disease Hypoglycaemia Infection suspected / confirmed Monitoring (short observation) Poor condition at birth Other 28% 28% 13% 8% 5% 18% Infection suspected / confirmed Respiratory disease Monitoring (short observation) Hypoglycaemia Jaundice Other Cheshire & Merseyside
Improve the early recognition and management of deterioration of either mother or baby during or soon after birth Surveillance, Benchmarking, Learning
Strategy for Success  Focus on patient  Focus on quality improvement  Quality improvements that will make a difference  Identify priorities  Evidence and Data to inform change and evaluation of impact  Working at different levels, local teams network wide, ODN wide and Nationally  Articulate what good looks like  Share good practice  Link and build relationships with people that can make change happen and ensure it is sustainable  Robust Governance
Thank You Julie.mccabe@alderhey.nhs.uk 07725515999
“Working together to provide the highest standard of care for babies and families” North West Neonatal Operational Delivery Network
Parents Gill & Matt “The staff and treatment we received were second to none”
Feeling great …skin to skin
Knitters
Parents Kerri & Lee *
Not now I’m resting
You can sit back mummy, look at me I am really comfy.
Parents Leanne & Dave Yes it’s been incredibly tough, but the mental and physical strength that Leanne showed has made me incredibly proud, not only as her husband, but now as the mother of my beautiful children.
* Parents Emma & Will “Our main advice is talk to the doctors and nurses”
Parents Caroline & James “I would definitely recommend going to the breastfeeding group”
Thank you for taking the time to raise funds…we really appreciate it!
Loving spending time with the family!!
Our support staff make a real difference, especially with smiles like these!!
Support groups are great fun…. and are not just for mums!!
Getting to know each other
Tender touch
Great use of a bariatric chair
Working in isolation can be hard, but is sometimes necessary.
I’m….wide awake!!
Families love to read other family’s stories
Big sister is right here
So many have done so much… Great job team!
Welcome to North West Coast Maternal and Neonatal Health Safety Learning System Mandy Townsend Innovation Agency: North West Coast
Presentation 1
• ‘A promise to learn - a commitment to act’ (Berwick 2013) made a series of recommendations to improve patient safety following the 2013 Francis Report • Patient Safety Collaborative (PSC) programme was created to support delivery of recommendations • PSC developed as a joint initiative between NHS Improvement and the AHSN Network • Local patient safety work plus 3 national workstreams: • Maternal and Neonatal • Deterioration • Patient Safety Culture Dr Phil Jennings, Medical Director Philip.Jennings@innovationagencynwc.nhs.uk Mandy Townsend, Associate Director Mandy.Townsend@innovationagencynwc.nhs.uk Andrew Cooper, Associate Director Andrew.Cooper@innovationagencynwc.nhs.uk Jen Gilroy-Cheetham, Programme Manager Jen.GilroyCheetham@innovationagencynwc.nhs. uk Charlotte Hall, Events Manager & facilitator Charlotte.Hall@innovationagencynwc.nhs.uk
By March 2020 each organisation, local maternity system and network will have: • significant capability and capacity for improvement • detailed knowledge of the local safety culture • understood their priorities and gaps, and developed a local improvement plan • made significant improvement to the local service and system quality and safety • data to share with their board, patients, staff and commissioners that reflect these improvements …to create the conditions for a safety culture and a national maternal and neonatal learning system ….so - Learning Systems!
• The Method for Improvement (IHI) • Measurement for Improvement • IHI Safety Culture Model • Safety Culture Assessment (SCORE) • Life QI project management platform • Coaching Academy • QI basics & Bronze level QI e-learning coming soon
• A safety culture: • a mind-set and a set of behaviours that become the very essence of what we do so that working safely is embedded into our beliefs, customs, social behaviour, ‘the way we do it round here • is mindful for the potential for getting it wrong, for risk and harm, one that takes steps to prevent that and to minimise its effects if it does • seeks to learn when things do go wrong or nearly go wrong; learn so that things can be changed to the system to the designs of what we do to intuitively help us get it right • one that seeks to learn from the day to day and seeks to learn from when we get it right in order to replicate it, and seeks a way of optimising what we know we do well • Not ‘one person’s job’ or a topic of ‘patient safety’ but helping people work safely • To quote Sign up to Safety: We believe that in order to do this we need a different way of working together. One where we are kind and respectful of each other. That we need to help people connect and create the relationships that are vital for safety; where people are able to speak out, and are listened to when they do. This culture needs to be fair and consistent both when things have gone wrong and when things have gone right; a ‘just culture’. A Learning Culture
Transparency Leadership Psychological Safety Negotiation Teamwork & Communication Accountability Reliability Improvement & Measurement Continuous Learning Engagement of Patients & Family Facilitating and mentoring teamwork, improvement, respect and psychological safety. Creating an environment where people feel comfortable and have opportunities to raise concerns or ask questions. Being held to act in a safe and respectful manner given the training and support to do so. Developing a shared understanding, anticipation of needs and problems, agreed methods to manage these as well as conflict situations Gaining genuine agreement on matters of importance to team members, patients and families. Regularly collecting and learning from defects and successes. Improving work processes and patient outcomes using standard improvement tools including measurements over time. Applying best evidence and minimizing non-patient specific variation with the goal of failure free operation over time. Openly sharing data and other information concerning safe, respectful and reliable care with staff and partners and families. © IHI and Allan Frankel Learning System Culture
What is a Learning System? Innovation Agency: North West Coast
• A forum for local improvement to be shared and to thrive • An opportunity for all stakeholders to work collaboratively • An opportunity for increasing local improvement capability • Opportunities for system level improvement / scale up within each learning system • Support for LMSs, SCNs and ODN • A sustainable solution for maternal and neonatal improvement • a safe and continuously improving culture 121
Similar to Community of Practice • clear ‘common interest’ • agreed ground rules - National Terms of Reference • shared archive • everyone involved is viewed as equal • 'supported' - sponsored by the PSC, ODN, SCNs & LMSs • common aim - To build knowledge and skills for patient safety & continuous improvement in maternity & neonatal services • support health professionals with knowledge, experience, and resources • CoP v LS (probably the biggest difference) with a LS we can impose rules and regulations, and can influence the agenda and who is a member • We will do this together (Co-design agenda)
http://www.agilebuddha.com
Lancashire & South Cumbria Cheshire & Mersey Learning Events Facebook closed (private) group SCN ODN SCN ODN SCN ODN
Working together to improve maternal and neonatal outcomes Mandy Townsend Associate Director, Patient Safety & Lead for Maternal & Neonatal #MatNeo #MatNeoQI #SaferNWC
• Support and enable Learning System • Learning Events • LMS QI leads sessions • Link in to and attend SCN, ODN and LMS Groups • Debriefing Support for Culture survey (SCORE) • Local coaching support- a bit of hand holding (if you want it!) • Life QI, and support to implement • QI basics sessions for upto 15 people on site
Building the Learning System This Photo by Unknown Author is licensed under CC BY-SA
Activity This Photo by Unknown Author is licensed under CC BY-SA
High performing teams #1 Psychological safety – teams felt able to speak up, to offer ideas without being shot down, there was high sociability among team members #2 Dependability – team members felt they could rely on each other to do what they committed to, and to a high standard #Structure and clarity – the team knew their objectives and had resources to do them #Meaning – the team were motivated by shared purpose and balues #Visible impact – the team were able to see the fruits of their labour, and how it contributed to the bigger picture This Photo by Unknown Author i licensed under CC BY- NC
A team climate where it is safe to take interpersonal risks and be vulnerable in front of each other. A sense of confidence that the team will not embarrass, reject or punish someone for speaking up. Psychological Safety Interdependence Uncertainty
Who is doing what? This Photo by Unknown Author is licensed under CC BY
• 0 – not doing work in this area • 1 – Just started a programme • 2 – Work in progress • 3 – Have some learnings to share Where are you?
What do we want from our community? • How do we use our Facebook group? • Are there any speakers we would like to hear from? • Are there any workshops that would help us learn? • How do we want to connect with eachother?
Activity This Photo by Unknown Author is licensed under CC BY-SA
#LiberatingStructures Crowd sourcing One idea or problem you think the community should work on together?

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North West Coast Maternity and Neonatal Learning System

  • 1.
    North West Coast Maternityand Neonatal Learning System
  • 2.
    The Birth andEvolution of Improving me Catherine McClennan Programme Director
  • 3.
    It started withclinical outcomes……
  • 4.
    0 2 4 6 8 10 12 14 16 18 20 Liverpool W. CheshireWarrington Halton Wirral Southport and Formby St Helens West Lancashire South Sefton Knowsley National Average Smoking at time of Delivery % 50.9 68.2 60.7 52.3 56.7 54 52.3 40.8 73.9 29.1 39.3 34.2 22.1 31 27.5 22.1 17.5 47.2 0 10 20 30 40 50 60 70 80 Liverpool W. Cheshire Warrington Halton Wirral Sefton St Helens West Lancashire Knowsley National Average Breastfeeding Rates % 20% of women develop mental health problem in pregnancy Less than 50% formally diagnosed 10% Dads suffer too Costs UK £8.1b per annum Estimates 5 x cost of improving services 63,311 59,714 38,862 23,939 28,680 106,084 46,084 32,459 56,438 19,609 Cheshire East Cheshire West and Chester Warrington Halton Knowsley Liverpool Sefton St.Helens Wirral West Lancs Women of Childbearing Age 2015 ……..and population data
  • 5.
    We spoke toWomen & Families
  • 6.
    We created Improvingme WOMEN BABIES MEN FAMILIES COMMUNITIES WORKFORCE To deliver excellent experiences for women, babies and their families To offer informed choices and care closer to home To reduce variation across services and improve outcomes To provide safe, high quality, equitable services
  • 7.
    Maternity Gynaecology Neonatal Paediatric Cheshireand Merseyside Women's and Children's Partnership Clinical and Operational Networks Clinical Commissioning Groups Providers People • Acute Care Collaboration Vanguard. • Only Vanguard with exclusive focus on women’s and children’s services. • Formation of Cheshire and Merseyside Women’s and Children’s Services Partnership. • 27 NHS Organisations working together to develop New Models of Care. • Opportunity to do things differently. We formed a Partnership
  • 8.
    We rallied thetroops  Appointed Clinical and Nurse leads  Created and utilised clinical networks  Provided summits to voice concerns, share ideas and co-design  Became a partnership  Developed robust governance framework  Became a system with a vision, a mission & values  We collaborated and broke down barriers  We involved people
  • 9.
  • 10.
    We developed acase for change “Staffing ‘inadequate’ at baby death hospital“ (BBC, 2017) “Hospitals forced to suspend acute services due to lack of doctors and nurses” (ITV, 2016) “Family in line for massive NHS pay out after baby suffered brain damage during birth” (Liverpool Echo, 2017) “NHS suffering 'virtual storm' of financial pressures” (BBC, 2017) The key messages are: Patient safety is being compromised by workforce shortages, resulting in sub-optimal clinical outcomes. Access to care outside of a hospital setting is limited with patients receiving insufficient choice. Services are not financially sustainable in their current form. Cheshire and Merseyside Delivering the Five Year Forward View 29% of Obstetric & Gynaecology medical roles and 22% of Paediatric medical roles were vacant in November 2016 30% variation in the proportion of pre- labour caesarean sections performed before 39 weeks of gestation without clinical indication as one example of outcome variation 3/8providers do not offer alongside-midwife led provision while there are no free- standing midwife- led units. Home birth rates are half the national average 0/8 providers are fully compliant with BAPM standards for medical and nursing staff 0/8 providers are fully complaint with the RCPCH Facing the Future standards (SCN audit, 2016) 6/8obstetric units across Cheshire & Merseyside are classified as “small” given they have annual birthing figures of less than 3,500 births >10% the standardised and adjusted neonatal mortality rate – an adverse outlier when compared to the UK average 68% of all A&E attendances result in discharge without significant treatment or follow-up treatment by a GP Source: Commissioner SUS Data (2015/16) Source: Neonatal Data Analysis Unit (2015) Source: NWNODN (2017) Source: RCOG (2016) Source: NHS Digital Source: Provider Data Returns In Cheshire & Merseyside: 1 2 3 Source: HEE
  • 11.
    We went ona journey….  ‘The lord giveth and the lord taketh away’ (Job1:21)  ‘Say hello and wave goodbye’  We grew and evolved  We put women and children first  We included men and the workforce and partners and friends  We created hope and a belief that change would come  That it was positive and needed  That this time it would happen
  • 12.
    Partnerships Clinical Delivery Networks Cross-Cuttingtheme of STP Maternity Pioneer Maternity Early Adopter Clinical Summits Consensus for new models of care We Collaborated for Change
  • 13.
    We created atemplate for new models of care
  • 14.
    We embraced BetterBirths Consistent principles nationally, with flexibility to implement locally
  • 15.
     Workforce Lead Cheshire and Merseyside Collaborative Advanced Paediatric Nurse Practitioner Programme and the creation of Advance  Cross-provider training in Hypno-birthing  Maternity Support Workers working in community to support BB Community and Health Improvement  COM-B programme completed by Bridgewater community midwifery team  Paediatric support for Primary Care  Midwifery Conference – ‘Caring for You’ October 2017  Shared Services and Shared teams developing  Provider Road shows  Royal Colleges engaged  Cheshire and Merseyside approach to vacancy, recruitment and retention issues  Central to redesign of New Models of Care We respected our workforce
  • 16.
    We ensured weare part of the future
  • 17.
    We Met BravePeople Along the Way
  • 18.
    We seized theopportunity to do things differently  The Brink  The Female mind  Game Changer  Baby Boxes  Advance  Pop-Up MLUs  Social prescribing  Neomates  PMCBs  Innovation and Technology
  • 19.
    We ensured that‘we are family’
  • 20.
    And we achieved….. Case for Change  Baseline outcomes mapped by providers  Clinical Delivery Networks established and Meet regularly  W&C data collection  Redesign workshops held for Gynaecology, Maternity, Neonatology & Paediatrics  Workforce Strategy  Communication Strategy  Option Appraisal Process commenced  Review of Neonatal Intensive Care Services complete
  • 21.
    Our Achievements  PaediatricPrimary & Secondary Interface Group  Joint approach to Public Health o Smoking o Pertussis vaccination rates improved o Maternal Flu Improvement Plan o Health improvement  Health as a social movement  Neonatal Activity, Capacity, Demand and Cot requirement review  Neonatal surgical pathway review and options appraisal  Integrated Palliative Care Pathway  C&M midwifery strategy
  • 22.
    Our Achievements  Positiveengagement with family groups  Launch of C&M Maternity Voices  Innovation and Technology  Development of a New Care Models product library  Delivered Neonatology ICU option appraisal recommendations  Working with the Innovation Agency to create a Maternity Cluster  Pop Up MLU opening at Seacombe Children’s Centre  Evaluation Focus Groups held and more in progress  Working collaboratively with Walton Vanguard  Clinical Scenarios developed for consultation  New Models created and shift to community hub delivery model  Clinical Summits held  Partnership with Libraries and Museums as part of cultural manifesto  Roll out of 30,000 Baby Boxes
  • 23.
    Our Achievements  SocialPrescribing Platform  Neonatal procurement consortium created  Continuity of carer audit undertaken and teams identified  Delivered draft blueprint to C&M system leaders  Clinical Advisory Group  Key work stream for STP
  • 24.
    BetterHealth •Improving Outcomes •Reducing Variation •StandardisedPathways •Quality Dashboards •Prevention •Public Health •Community engagement •Health as a social movement •Education •Family Focus •Integrated care •Population Health •Self Care BetterCare • Improved Quality • Care Closer to home • Patient focus • Consistency of Approach • Single Point of Access • Less confusion • Standardised pathways of care • Workforce support • New Roles • CQC outcomes • Safety Collaborative • Reduced separation • Electronic records • Clinical Networks • MDT • Shared services • Cross-provider & lead provider models BetterValue • Right care, right place, right professional • Consistency • Shared pathways • Reduced repetition • Joint services • Reduction in complaints • Reduction in CNST • System delivery • Network procurement • New pricing models • Lead provider • IMT & Innovation • Workforce used in different way • Social Value • New partnerships • Speciality Provision • Redesign of service delivery points We will deliver Our ambition!
  • 25.
    Be brave, bebold……. but above all else do something.
  • 26.
    The Journey soFar Vanessa Wilson 5th June 2018
  • 27.
     Who? – Everyone Why? – Improve safety and reduce variation in care – Efficiencies and enhanced effectiveness – Make services more accessible and give women and families choice  When? – By 2021 Local Maternity System27
  • 28.
     Population of1.7 million (GP registration)  Population of 1.18 million (Based on residency)  Covering 3500 square miles (9065 sq kms)  Diverse populations, complexity & consanguinity  Geographically varied from rural to cities  Areas of high deprivation and health needs Context28
  • 29.
    Providers29 • 5 xproviders of maternity services • 10 x settings + Home Births • Circa 17,500 births per year • Bay – 3080 • Pennine – 6700 • Central – 4400 • Blackpool – 3300 • 2 x L3 Neonatal Units
  • 30.
    Programme Management30 Project Leadand SRO since October 2017 Secondment in ICS January 2018 for 12months Project Management Team recruited –2 x Project Managers –Family Engagement Coordinator –Admin and Project Support ‘adopted’ SCN maternity team - safety and peri- natal MH Now getting organised!
  • 31.
    Planning and Milestones31 •Transformation plan submitted and resubmitted • Trajectories established and agreed for • Number of women birthing in a low risk, midwifery led setting • Number of women being offered continuity of carer • Number of women with a Personalised Care Plan • Number of women given full choice of birth setting • Implementation Phase
  • 32.
  • 33.
     Out ofHospital / Community Hubs  Post Natal Care  Continuity of Carer / Workforce Development  Choice and Personalisation  Digital  Safety (SCN Safety SiG)  Neonatlogy (NWC ODN)  Perinatal Mental Health 8 Work Streams33
  • 34.
    34 • Work ForceScoping • Links established with Maternity Voices Partnerships • Communications Plan developed • Transformation Funding secured • NHS Resolution Incentive Scheme
  • 35.
     Geography  Culturechange required  System vs Silo  Competing priorities for organisations and individuals Key Challenges35
  • 36.
     Review andrevise governance arrangements and Terms of Reference to allow for delegated decision making  Increase profile of BB L&SC  Engagement events re CoC  Infant feeding Strategy Next Steps36
  • 37.
    Assembly Meeting 22ndJune – Gujarati Centre Preston  Please Come! https://www.eventbrite.co.uk/e/local-maternity- system-assembly-meeting-tickets-45721569445 Contact: vanessa.wilson6@nhs.net Contact Points and Details37
  • 38.
    Thank You forListening 38
  • 39.
    North West CoastMaternity and Neonatal Learning System Integrated working David Rowlands Clinical Lead for Maternity NW Coast Strategic Clinical Network June 2018
  • 40.
    Local Maternity Systemsacross NW Coast SCN • 2 LMS within the region – SCumbria & Lancs – Cheshire & Merseyside Vanessa Wilson Simon Banks
  • 41.
    Evolution • 7/13 –Maternity Children & Young People – became one of 5 statutory SCNs • 9/13 – Stakeholder group – Perinatal mental health – Standardising care in complex conditions – Pre term birth – Stillbirth – Reducing variation
  • 42.
    Perinatal Mental Health •Chair:Tania Stanaway now Gillian Strachan – Standardised pathway for depression – Increased community perinatal mental health provision – New mother and baby unit in NW Coast footprint – Asking the right questions at the right time – Parity of esteem
  • 43.
    Complex conditions • Chair:Helen Scholefield – Cardiac pathway – Critical care pathway – Diagnostics for placenta accreta / percreta – Thyroid disease guidelines – Diabetes (linking with diabetes network) – Hypertension – Renal – HIV – Morbid obesity
  • 44.
    Pathways of Care MaternityClinical Experts Group (inclusive of all providers; NWAS; safety collaborative, LMS, neonatal ODN etc) – Complexity guideline – emphasis on normalisation – Pre- eclampsia – Post partum haemorrhage – Sepsis – Prematurity
  • 45.
    Preterm labour • Chair:Sara Brigham – Standardised pathway for diagnosis & management of preterm labour including IUT – Emphasises multidisciplinary working; multiple providers including NWAS
  • 46.
    Reducing Variation Clinical Dashboard •Co- chairs – Simon Banks /David Rowlands RCOG Patterns of Maternity Care Clinical quality & safety Patient experience and choice Safeguarding
  • 47.
    NW Coast Dashboard Nationaldashboard 14 measures Front sheets reflecting national agenda – CNST 10; 2020 targets Phase One (Defined Metric Numbers) Phase Two (Provisional Metric Numbers) All Phases (Provisional Metric Numbers) Provider Submitted Metrics 74 63 137 Aggregated Metrics 101 59 160 Total Metrics 175 122 297
  • 48.
    Benefits • Standardise measures •Data accuracy • Mirror on what you are doing • Refection of what others are doing • Assurance tool • Early warning system • Service improvement tool
  • 49.
    Stillbirth SIG Chair SCumb& Lancs: Liz Martindale Chair C&M: Devender Roberts now Alice Bird – Stillbirth bundle – Grow charts – Each Baby counts – External attendance at RCA for stillbirth – Sharing lessons learned – Assuring implementation – Multiagency working
  • 50.
  • 51.
    • About average •But a bit higher than average • This equated to 8 more babies lost per year • We weren't and aren't happy with being average • We want to be the best!
  • 52.
  • 53.
    333 18 fewer than E&Waverage >25% reduction 36 fewer stillbirths
  • 54.
    Safety SIG • ChairS Cumbria & Lancs: David Burch • Co-Chairs C&M: Kate Alldred/Lynda Coughlin • Mandy Townsend – Dashboard review – Lessons learned – Maternity & Neonatal Health Safety Collaborative • Maximise benefits • Shared learning (not waiting for 3 waves) – HSIB
  • 55.
    Maternal and neonatalhealth safety collaborative Dec 2016 • to reduce the rates of maternal deaths, stillbirths, neonatal deaths and brain injuries that occur during or soon after birth by 20% by 2020 and 50% by 2030. 2025 • reducing national rate of pre-term births from 8% to 6% 2025 Will help all maternity care providers and commissioners to: • improve clinical practices • reduce unwarranted variation • report on how they are contributing to achieving the national ambition • 3 year programme - ongoing
  • 56.
    Opportunity • Fantastic tohave so much focus on Maternity • Maximise the benefits through integration • We are a true network – a Partnership • The strength of the network is its membership • Variation still exists • Come a long way • Long way to go • HSIB/ Better Births/ CNST 10/ RCOG Each Baby Counts/ Board Safety Champions
  • 57.
  • 58.
    Nicky Lyon’s challenge Campaignfor safer births (NHSI website) • How do you know your unit is delivering the safest care possible? How does your unit compare to others in the MBRRACE audit & National Maternity & Perinatal Audit data? • Is your unit following all current guidelines? Are they documented, trained, audited? • Are you investigating all Serious Incidents robustly with external representation and parental input invited? How are you supporting the staff in the unit to implement recommendations from these reviews? • Do you know how many stillbirths there have been in your unit? Do you know how many occurred during labour? How many Serious Incidents?
  • 59.
    • Do youread feedback and comments from parents in the Friends & Family Test and the Care Quality Commission questionnaire? What changes have you implemented in response to this feedback? • Have you checked the staff in the unit are receiving all the training, support and resources they need to do their job well? • Is multidisciplinary working developed at your trust – with joint training, briefings and handovers? • Have you briefed the board on maternity safety and the activity you would like to undertake to further improve? https://improvement.nhs.uk/resources/parents-view-my- challenge-board-level-maternity-safety-champions/
  • 60.
    It is amazingwhat you can accomplish if you do not care who gets the credit Harry S Truman By working together we can accomplish great things. Because it is the right thing to do.
  • 61.
    Maternity and NeonatalSafety Collaborative Safety is the state of being "safe", the condition of being protected from harm or other non-desirable outcomes Julie McCabe Network Director RGN RM BA MSc
  • 62.
    Neonatal Work Programme BetterHealth Improving Outcomes • Family integrated care • Reducing the number of babies separated from their mothers • Optimising Place of delivery • Network approach to the reduction in neonatal mortality • Workforce development Better care Improving Quality • Cardiac pathway • Integrated palliative care • Surgical pathway • Single neonatal surgical service • Neonatal outreach CQUIN • Network education and training • Workforce development Better value Right care, right place, right professional • Activity Capacity Demand review • Central capacity cot/bed management system • Network procurement • New Pricing and contracting models • Workforce planning
  • 63.
    Quality Improvements  NWNODNquality improvement programme  Maternity and Neonatal Transformation – local Maternity Systems  Better births implementation plan  Maternity and Neonatal Health Safety collaborative  Support maternal and neonatal care services to provide a safe, reliable and quality healthcare experience to all women, babies and families across maternity care settings in England  Create the conditions for continuous improvement, a safety culture and a national maternal and neonatal learning system.  Contribute to the national ambition of reducing the rates of maternal and neonatal deaths, stillbirths, and brain injuries that occur during or soon after birth by 20% by 2020.
  • 64.
    Births Code Cheshire andMerseyside Neonatal Network 28,573 ● Lancashire and South Cumbria Neonatal Network 16,986 ● Greater Manchester Neonatal Network 37,215 ● ● up to 10% higher than the average for the comparator group ● more than 10% higher than the average for the comparator group Neonatal Mortality EMBRRACE 2017
  • 66.
    5 key ClinicalInterventions 1. Improve the proportion of smoke free pregnancies 2. Improve the optimisation and stabilisation of the very preterm infant 3. Improve the detection and management of diabetes and management of diabetes in pregnancy 4. Improve the detection and management of neonatal hypoglycaemia 5. Improve the early recognition and management of deterioration of either mother or baby during or soon after birth
  • 67.
    Improve the proportionof smoke free pregnancies
  • 68.
    Improve the proportionof smoke free pregnancies
  • 69.
    Improve the optimisationand stabilisation of the very preterm infant <27 Week First Admissions Apr 16 – Mar 17 IC % NICUs 2015/16 2016/17 Greater Manchester 89% 90% Cheshire & Merseyside 73% 83% Lancashire & South Cumbria 89% 91%
  • 70.
    Optimising Outcomes Administration ofsteroids 24- 34/40 2015-2017 Eligible Mothers Steroids given (%) (N: National % ) Not given Missing/Unknown 2015 2439 2098 (84%) (N: 85%) 330 9 2016 2353 2011 (85%) (N: 85%) 299 43 2017 2318 2017 (87%) (N: 82.6) 223 78 Administration of Magnesium Sulphate < 30/40 2016 -2017 Eligible Mothers Magnesium Sulphate Given(%) (N: National % ) Not given Missing/Unknown 2016 586 205 (35%) (N: 39%) 188 193 2017 532 321 (60%) (N: 57.4%) 140 71 PReCePT: Reducing cerebral palsy through improving uptake of magnesium sulphate in preterm deliveries
  • 71.
    Improve the detectionand management of diabetes in pregnancy
  • 72.
    Improve the detectionand management of neonatal hypoglycaemia Term admissions by unit as % of total births 2.70% 11.30% 0.00% 2.00% 4.00% 6.00% 8.00% 10.00% 12.00% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 L&SC GM&EC C&M
  • 73.
    Top 5 reasonsfor Admission Lancashire and South Cumbria Greater Manchester & East Cheshire 36% 18% 13% 7% 4% 22% Respiratory disease Infection suspected / confirmed Hypoglycaemia Poor condition at birth Monitoring (short observation) Other 38% 11%9% 6% 4% 32% Respiratory disease Hypoglycaemia Infection suspected / confirmed Monitoring (short observation) Poor condition at birth Other 28% 28% 13% 8% 5% 18% Infection suspected / confirmed Respiratory disease Monitoring (short observation) Hypoglycaemia Jaundice Other Cheshire & Merseyside
  • 74.
    Improve the earlyrecognition and management of deterioration of either mother or baby during or soon after birth Surveillance, Benchmarking, Learning
  • 75.
    Strategy for Success Focus on patient  Focus on quality improvement  Quality improvements that will make a difference  Identify priorities  Evidence and Data to inform change and evaluation of impact  Working at different levels, local teams network wide, ODN wide and Nationally  Articulate what good looks like  Share good practice  Link and build relationships with people that can make change happen and ensure it is sustainable  Robust Governance
  • 76.
  • 77.
    “Working together toprovide the highest standard of care for babies and families” North West Neonatal Operational Delivery Network
  • 78.
    Parents Gill &Matt “The staff and treatment we received were second to none”
  • 79.
  • 80.
  • 81.
  • 82.
  • 83.
    You can sitback mummy, look at me I am really comfy.
  • 86.
    Parents Leanne & Dave Yes it’sbeen incredibly tough, but the mental and physical strength that Leanne showed has made me incredibly proud, not only as her husband, but now as the mother of my beautiful children.
  • 88.
    * Parents Emma &Will “Our main advice is talk to the doctors and nurses”
  • 90.
    Parents Caroline & James “Iwould definitely recommend going to the breastfeeding group”
  • 91.
    Thank you fortaking the time to raise funds…we really appreciate it!
  • 93.
  • 95.
    Our support staff makea real difference, especially with smiles like these!!
  • 99.
    Support groups are greatfun…. and are not just for mums!!
  • 102.
  • 103.
  • 105.
    Great use ofa bariatric chair
  • 107.
    Working in isolationcan be hard, but is sometimes necessary.
  • 108.
  • 109.
    Families love to readother family’s stories
  • 110.
    Big sister isright here
  • 112.
    So many havedone so much… Great job team!
  • 113.
    Welcome to NorthWest Coast Maternal and Neonatal Health Safety Learning System Mandy Townsend Innovation Agency: North West Coast
  • 114.
  • 115.
    • ‘A promiseto learn - a commitment to act’ (Berwick 2013) made a series of recommendations to improve patient safety following the 2013 Francis Report • Patient Safety Collaborative (PSC) programme was created to support delivery of recommendations • PSC developed as a joint initiative between NHS Improvement and the AHSN Network • Local patient safety work plus 3 national workstreams: • Maternal and Neonatal • Deterioration • Patient Safety Culture Dr Phil Jennings, Medical Director Philip.Jennings@innovationagencynwc.nhs.uk Mandy Townsend, Associate Director Mandy.Townsend@innovationagencynwc.nhs.uk Andrew Cooper, Associate Director Andrew.Cooper@innovationagencynwc.nhs.uk Jen Gilroy-Cheetham, Programme Manager Jen.GilroyCheetham@innovationagencynwc.nhs. uk Charlotte Hall, Events Manager & facilitator Charlotte.Hall@innovationagencynwc.nhs.uk
  • 116.
    By March 2020each organisation, local maternity system and network will have: • significant capability and capacity for improvement • detailed knowledge of the local safety culture • understood their priorities and gaps, and developed a local improvement plan • made significant improvement to the local service and system quality and safety • data to share with their board, patients, staff and commissioners that reflect these improvements …to create the conditions for a safety culture and a national maternal and neonatal learning system ….so - Learning Systems!
  • 117.
    • The Methodfor Improvement (IHI) • Measurement for Improvement • IHI Safety Culture Model • Safety Culture Assessment (SCORE) • Life QI project management platform • Coaching Academy • QI basics & Bronze level QI e-learning coming soon
  • 118.
    • A safetyculture: • a mind-set and a set of behaviours that become the very essence of what we do so that working safely is embedded into our beliefs, customs, social behaviour, ‘the way we do it round here • is mindful for the potential for getting it wrong, for risk and harm, one that takes steps to prevent that and to minimise its effects if it does • seeks to learn when things do go wrong or nearly go wrong; learn so that things can be changed to the system to the designs of what we do to intuitively help us get it right • one that seeks to learn from the day to day and seeks to learn from when we get it right in order to replicate it, and seeks a way of optimising what we know we do well • Not ‘one person’s job’ or a topic of ‘patient safety’ but helping people work safely • To quote Sign up to Safety: We believe that in order to do this we need a different way of working together. One where we are kind and respectful of each other. That we need to help people connect and create the relationships that are vital for safety; where people are able to speak out, and are listened to when they do. This culture needs to be fair and consistent both when things have gone wrong and when things have gone right; a ‘just culture’. A Learning Culture
  • 119.
    Transparency Leadership Psychological Safety Negotiation Teamwork & Communication Accountability Reliability Improvement & Measurement Continuous Learning Engagement ofPatients & Family Facilitating and mentoring teamwork, improvement, respect and psychological safety. Creating an environment where people feel comfortable and have opportunities to raise concerns or ask questions. Being held to act in a safe and respectful manner given the training and support to do so. Developing a shared understanding, anticipation of needs and problems, agreed methods to manage these as well as conflict situations Gaining genuine agreement on matters of importance to team members, patients and families. Regularly collecting and learning from defects and successes. Improving work processes and patient outcomes using standard improvement tools including measurements over time. Applying best evidence and minimizing non-patient specific variation with the goal of failure free operation over time. Openly sharing data and other information concerning safe, respectful and reliable care with staff and partners and families. © IHI and Allan Frankel Learning System Culture
  • 120.
    What is aLearning System? Innovation Agency: North West Coast
  • 121.
    • A forumfor local improvement to be shared and to thrive • An opportunity for all stakeholders to work collaboratively • An opportunity for increasing local improvement capability • Opportunities for system level improvement / scale up within each learning system • Support for LMSs, SCNs and ODN • A sustainable solution for maternal and neonatal improvement • a safe and continuously improving culture 121
  • 122.
    Similar to Communityof Practice • clear ‘common interest’ • agreed ground rules - National Terms of Reference • shared archive • everyone involved is viewed as equal • 'supported' - sponsored by the PSC, ODN, SCNs & LMSs • common aim - To build knowledge and skills for patient safety & continuous improvement in maternity & neonatal services • support health professionals with knowledge, experience, and resources • CoP v LS (probably the biggest difference) with a LS we can impose rules and regulations, and can influence the agenda and who is a member • We will do this together (Co-design agenda)
  • 123.
  • 125.
    Lancashire & South Cumbria Cheshire & Mersey Learning Events Facebookclosed (private) group SCN ODN SCN ODN SCN ODN
  • 126.
    Working together to improvematernal and neonatal outcomes Mandy Townsend Associate Director, Patient Safety & Lead for Maternal & Neonatal #MatNeo #MatNeoQI #SaferNWC
  • 127.
    • Support andenable Learning System • Learning Events • LMS QI leads sessions • Link in to and attend SCN, ODN and LMS Groups • Debriefing Support for Culture survey (SCORE) • Local coaching support- a bit of hand holding (if you want it!) • Life QI, and support to implement • QI basics sessions for upto 15 people on site
  • 128.
    Building the LearningSystem This Photo by Unknown Author is licensed under CC BY-SA
  • 138.
    Activity This Photo byUnknown Author is licensed under CC BY-SA
  • 140.
    High performing teams #1Psychological safety – teams felt able to speak up, to offer ideas without being shot down, there was high sociability among team members #2 Dependability – team members felt they could rely on each other to do what they committed to, and to a high standard #Structure and clarity – the team knew their objectives and had resources to do them #Meaning – the team were motivated by shared purpose and balues #Visible impact – the team were able to see the fruits of their labour, and how it contributed to the bigger picture This Photo by Unknown Author i licensed under CC BY- NC
  • 141.
    A team climatewhere it is safe to take interpersonal risks and be vulnerable in front of each other. A sense of confidence that the team will not embarrass, reject or punish someone for speaking up. Psychological Safety Interdependence Uncertainty
  • 144.
    Who is doing what? ThisPhoto by Unknown Author is licensed under CC BY
  • 145.
    • 0 –not doing work in this area • 1 – Just started a programme • 2 – Work in progress • 3 – Have some learnings to share Where are you?
  • 146.
    What do wewant from our community? • How do we use our Facebook group? • Are there any speakers we would like to hear from? • Are there any workshops that would help us learn? • How do we want to connect with eachother?
  • 147.
    Activity This Photo byUnknown Author is licensed under CC BY-SA
  • 148.
    #LiberatingStructures Crowd sourcing One ideaor problem you think the community should work on together?