Presentation on the North West Coast Maternity and Neonatal Learning System at Haydock Holiday Inn, Haydock, 5 June 2018

1. North West Coast
Maternity and Neonatal
Learning System

2. The Birth and Evolution of
Improving me
Catherine McClennan
Programme Director

3. It started with clinical outcomes……

4. 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

5. We spoke to Women & Families

6. 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

7. 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

8. 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

9. We dealt with……

10. 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

11. 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

12. 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

13. We created a template for new
models of care

14. We embraced Better Births
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 we are part of the future

17. We Met Brave People Along the Way

18. 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

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
 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

22. 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

23. 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

24. 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!

25. Be brave, be bold…….
but above all else do something.

26. The Journey so Far
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 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

29. 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

30. 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!

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. Governance Arrangements32

33.  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. 34
• Work Force Scoping
• Links established with Maternity Voices Partnerships
• Communications Plan developed
• Transformation Funding secured
• NHS Resolution Incentive Scheme

35.  Geography
 Culture change required
 System vs Silo
 Competing priorities for organisations and
individuals
Key Challenges35

36.  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

37. 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

38. Thank You for Listening
38

39. North West Coast Maternity and
Neonatal Learning System
Integrated working
David Rowlands Clinical Lead for Maternity
NW Coast Strategic Clinical Network
June 2018

40. Local Maternity Systems across
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
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

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
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

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. Stillbirth rate

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. Stillbirth rate

53. 333
18 fewer than
E&W average
>25% reduction
36 fewer stillbirths

54. 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

55. 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

56. 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

57. Thought for the day

58. 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?

59. • 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/

60. 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.

61. 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

62. 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

63. 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.

64. 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

66. 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

67. Improve the proportion of smoke free pregnancies

68. Improve the proportion of smoke free pregnancies

69. 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%

70. 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

71. Improve the detection and management of
diabetes in pregnancy

72. 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

73. 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

74. Improve the early recognition 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. Thank You
Julie.mccabe@alderhey.nhs.uk
07725515999

77. “Working together to provide 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. Feeling great …skin to skin

80. Knitters

81. Parents Kerri & Lee
*

82. Not now I’m resting

83. You can sit back
mummy, look at
me I am really
comfy.

86. 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.

88. *
Parents Emma & Will
“Our main advice is
talk to the doctors
and nurses”

90. Parents Caroline &
James
“I would definitely recommend going to
the breastfeeding group”

91. Thank you for taking the time to
raise funds…we really appreciate it!

93. Loving spending
time with the
family!!

95. Our support staff
make a real difference,
especially with smiles
like these!!

99. Support groups
are great fun….
and are not just for mums!!

102. Getting
to know
each
other

103. Tender
touch

105. Great use of a bariatric chair

107. Working in isolation can be hard,
but is sometimes necessary.

108. I’m….wide awake!!

109. Families love
to read other
family’s stories

110. Big sister is right here

112. So many have done so much…
Great job team!

113. Welcome to North West
Coast Maternal and
Neonatal Health Safety
Learning System
Mandy Townsend
Innovation Agency:
North West Coast

114. Presentation 1

115. • ‘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

116. 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!

117. • 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

118. • 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

119. 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

120. What is a Learning
System?
Innovation Agency:
North West Coast

121. • 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

122. 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)

123. http://www.agilebuddha.com

125. Lancashire
& South
Cumbria
Cheshire
& Mersey
Learning
Events
Facebook closed (private)
group
SCN
ODN
SCN
ODN
SCN
ODN

126. Working together to
improve maternal and
neonatal outcomes
Mandy Townsend Associate Director,
Patient Safety & Lead for Maternal &
Neonatal
#MatNeo
#MatNeoQI
#SaferNWC

127. • 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

128. Building the Learning System
This Photo by Unknown Author is licensed under CC BY-SA

138. Activity
This Photo by Unknown Author is licensed under CC BY-SA

140. 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

141. 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

144. Who is doing
what?
This Photo 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 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?

147. Activity
This Photo by Unknown Author is licensed under CC BY-SA

148. #LiberatingStructures
Crowd sourcing
One idea or problem
you think the
community should work
on together?