Effectively realising change

Midwives magazine: Issue 7 :: 2011

Lessons from the The King’s Fund’s Safer Births Improvement Programme can be applied to affect other large-scale changes for good, explains Vinice Thomas, service improvement lead on the project.

If a review was conducted of recent reports or inquiries into the quality and safety of maternity units, a commonality in the recurrent themes that emerge from the recommendations would be found.

Issues such as strengthening leadership, improving communication, developing clinical skills and training, and better team-working, have featured in a number of such reports (CMACE, 2011; Department of Health, 2007).

When The King’s Fund commissioned its own independent inquiry into the safety of maternity services within England in 2008, the subsequent report, Safe births: everybody’s business, also identified similar themes for improving safety. The key recommendations, outlined in the table opposite, are not new in themselves, but further highlight a key challenge for maternity teams: how best can these factors be addressed in a sustainable way? This article looks at some of the learning that arose out of a national improvement programme, and was considered by the participants as being key to the successful delivery of projects to improve team-working, communication, strengthen leadership and, ultimately, care.

The SBIP
As a means of enabling maternity teams to improve safety and implement the key recommendations from The King’s Fund inquiry, the Safer Births Improvement Programme (SBIP) was developed in partnership with national bodies with a key focus on maternity safety (see below).

One of the objectives of the SBIP was to support maternity teams in delivering a programme that would deal with local safety issues within the maternity unit, by addressing one or more of the factors identified in the Safe births inquiry. The King’s Fund and its partners developed and delivered a bespoke programme of support to 12 maternity teams over 18 months.

Reflecting on their participation in the SBIP, the 12 maternity teams identified key issues that enabled the successful implementation of their safety projects.

Key lessons
Competing priorities
The maternity teams reported a sense of ‘juggling many balls’, and contending with competing priorities, such as trust mergers, moving to ‘new builds’ and organisational restructuring, while preparing for the Clinical Negligence Scheme for Trusts assessments or participating in a national improvement programme.

Introducing a programme of change at such a time had the potential to leave some staff feeling ‘overwhelmed’ and ‘disengaged’.

To help resolve this, a robust action plan, which clearly articulated the measures of success and the desired future state, was considered to be beneficial in providing a focused approach
to the change programme and a well-defined remit.

It was highlighted that there was a need to develop annual work plans that viewed key changes and developments within the department holistically and not in silos, thus enabling a more coordinated approach to these activities and appropriate allocation of resources and personnel. 

Staff engagement
Consultation with staff, and providing the opportunity for staff to own and shape the change, was vital to any amendments being embedded and sustained beyond the life of the SBIP.
 
Leaders at all levels of the workforce are vital to driving forward improvement and gaining staff commitment. As such, there is a need for leaders to be able to articulate the vision, inspire their peers and maintain momentum.

In addition, the ongoing support of senior management and the trust board sponsors was considered invaluable to help overcome some of the resistance to change that the teams encountered, and to secure additional resources as required. 

Protected time
Protected time for staff innovation is key and must not necessarily be sacrificed. Most of the maternity teams agreed the protected time enabled ‘space’ for creative thinking and problem-solving, not to mention the networking opportunities with colleagues. This in itself helped avoid the ‘re-inventing the wheel’ scenario, which many of the participating teams felt had hampered any progress in improving care previously.

Creating sustainability
Sustainability of an improvement project can be a challenge if it has not been planned for at the outset. The application of a sustainability tool can be useful to identify the areas where further work is required to ensure the change process is implemented. It is important to identify values that can hamper the change process.

To help ensure sustainability, it was considered vital to introduce team and individual objectives around the areas of change, and to ensure ongoing monitoring, auditing and action until the practice became part of the core business.

Each organisation should be aware of their ‘hotspots’, in terms of resistance to change, and proactively engage with such staff groups or clinical areas.

Further support
To ensure the longevity of any improvement project, the widespread sharing of lessons – at a local and national level – is vital.

The lessons from the SBIP have been captured in a short DVD and an information resource pack, which will be launched by The King’s Fund and its partners later this year. 


Safer Births improvement programme partners
RCOG - Royal College of Obstetricians and Gynaecologists

RCM - Royal College of Midwives

NPSA - National Patient Safety Agency

CMACE - Centre for Maternal and Child Enquiry

CQC - Care Quality Commission

NHSLA - NHS Litigation Authority


Summary of the recommendations from the Safe Births inquiry as given in Safe Births: Everybody’s Business (2008)
Safe maternity teams
Safe maternity teams need clear team objectives, roles, effective leadership and clear procedure for communication
Staffing for safety
Safe maternity teams need adequate numbers of staff with the right skills
Training for safety
Individual members must have the right skills and training, as well as appropriate resources
Guidance on safe practice
Safe practice must be based on evidence and set out in guidelines, protocols and other forms of guidance
Information for safety
Information needs to be used for formative purposes to help maternity teams assess and improve their work
The role of trust boards
Trust boards to communicate and prioritise safety to staff and patients and demand rigorous routine information
National structures for safety
National bodies to work more closely together to provide a more ‘whole system’ approach to safety


Further information is available at: www.kingsfund.org.uk/saferbirths


References

Centre for Maternal and Child Enquiries (CMACE). (2011) Saving mother’s lives: reviewing maternal deaths to make motherhood safer: 2006-2008. BJOG: an International Journal of Obstetrics and Gynaecology 118(Suppl 1): 1-203.

Department of Health. (2007) Maternity matters: choice, access and continuity of care in a safe service. HMSO: London. See: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073312 (accessed 14 November 2011).

The King’s Fund. (2008) Safe births: everybody’s business. An independent inquiry into the safety of maternity services in England, London. See: http://www.kingsfund.org.uk/publications/safe_births.html (accessed 14 November 2011).