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Simon Cunningham: How the Safer Births Programme has made a difference to quality and safety
The Safer Births Programme made improvements to maternity care at MCHT Crewe over time. Key changes included implementing tools like SBAR for better communication, a buddy system for hourly CTG reviews, and a birthrate acuity tool for escalation. These helped increase teamwork and coordination. Outcomes included higher ratings for safety culture, fewer CTG misinterpretations, and decreased rates of low cord gases and postpartum hemorrhage. Lessons included involving staff earlier and maintaining momentum with continued initiatives to further normalize safe practices.
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Simon Cunningham: How the Safer Births Programme has made a difference to quality and safety
- 1. How the SaferBirths Programme made a difference Mr Simon Cunningham Acknowledgments to Denise Horne & Cath Murray Developing Better Maternity Care Conference The King’s Fund, March 2012
- 2. Overview • Background ofthe project & organisation • Key issues & change of approach • Timeline • Outcomes & changes in practice • Key lessons • Future
- 3. Background • The placeMCHT Crewe and its surrounding areas (Population of 300,000) • Foundation trust in 2008 • 60 hour / week labour ward cover since early 2010 • Three levels of consultant involvement • Four heads of midwifery & three GDM / ADD’s
- 4. The safer birthsinitiative • Decrease CTG misinterpretation • Decrease low cord gases • Decrease PPH rates • Better use of the maternity information system
- 5. The safer birthsinitiative 2.0 • Better teamworking • Better communication • Adoption of national tools for patient safety
- 6. Manchester patient safetyframework • MaPSaF • Maturity, culture & perception • Teamworking domain scored B (reactionary) • Ideas for service improvement • Congruence with governance issues
- 7. Teamworking • What definesyour team? • How easy is it to communicate ideas ? • Roles & goals • Loafing versus labouring • Topdown for direction. Ground up for solutions
- 8. Initiatives • Communication tools •Buddy CTG system • Birthrate acuity & NPSA intrapartum tools • Communication of change • Postpartum haemorrhage
- 9. SBAR • Situation BackgroundAssessment Recommendation • Flattens the hierarchy • Streamlines & standardises • Promotes continuity • Reduces frustration !!!
- 10. SBAR • CHAPS usedby a cluster partner • Ownership by staff • Mandatory training • Distributed throughout care pathway
- 11. SBAR • CHAPS usedby a cluster partner • Ownership by staff • Mandatory training • Distributed throughout care pathway
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- 13. Birth rate acuity& escalation
- 14. Birth rate acuity •Embedding • Escalation policy • Audit • Elective activity • Low cord gases
- 15. Birth rate acuity •Embedding • Escalation policy • Audit • Elective activity • Low cord gases
- 16. Buddy system • Followedtwo root cause analyses • Hourly (first stage), 30 mins (second stage) • Reinforced K2 and mandatory training • Created environment for discussion
- 17. Buddy system It’s that Buddy time again! A fresh pair of eyes… On the hour, every hour
- 18. Buddy system • Habit • Ad hoc • Guidance revised by LWC • Not clearly understood • Drove it • Not reinforced • Directed to problem • All EFM traces • Rolling audit
- 19. Labour ward co-ordinators consultancyday 10.00 Welcome and introductions Overview and update on SBIN project • 10.15 Agreeing purpose and expectations • A day in the life of a Labour Ward Co-ordinator Triumphs and tribulations LWC as leader • 11.30 Break • 11.50 What’s my style? How do I like to do things, how do I work with others? • 13.00 Lunch • Introducing change and making it stick Working with real issues identifying:
- 20. Labour ward co-ordinators consultancy day • “We have achieved more today than we might in weeks or months on the unit” • “It has been excellent to spend the day together - it is the first time we have all been in the same room.” • “I think we have worked together well - we have had different ideas but have been able to agree some good ways forward. It’s good to get the feeling of working as a team”
- 21. Outcomes • MaPSAF: B/Cinto C/D. • Reactive into bureaucratic into proactive • Triage & induction areas made • SBAR across the board • Escalation policy works… • Buddy system embedded • Dissemination of guidance/practice
- 22. What went well •Culture versus strategy • Cluster days • Consultancy days • Core days • MDT
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- 26. Next time we’d •Involve more people sooner • Board support • Mentor sites • Postpartum haemorrhage
- 27. How has ……? •Look behind the headlines • Creating a movement • Pseudoteams • Sell, buy, own • Network • MDT works
- 28. Moving on • Shareddecision making project with AQUA • Normality • Antenatal care pathways • Screening & fetal med • Postnatal care & parentcraft • Complex social care • Bereavement & Post-traumatic stress
- 29. • “You don’treduce caesarean section rates with policies and guidelines you do it by changing the people” • Professor James Walker, first core meeting at The King’s Fund, October 2009.