Safe care starts with positive culture

By Gill Walton, Chief Executive on 04 December 2020

I am so aware of how midwives and maternity teams have stepped up, have been innovative and have kept smiling behind their masks in order to give the best possible care to women during the pandemic. I am so proud to be part of this profession.

Then I hear about the services that have been deemed unsafe and care that has been substandard. It is never a simple story as to why some services have ended up in that space. Women and babies and the staff involved in those sad incidents are all harmed. However, staff working in those services still come to work every day and try their best, but often in the face of complex adversity. I have seen it happen many times before; failing services keep failing, and the media highlight every mistake in glorious technicolour and still the staff come to work.

How can we all break this cycle of harm? Every service, the population it serves and the folklore and history that are the roots of a culture all need different understanding and approaches. One size most definitely does not fit all. I have seen many times the one size fits all approach causing more harm rather than improvement. Over scrutiny, blame, targeting of individuals and groups of staff, action plans galore and action plans to manage the action plans to satisfy up the chain!

Enough is enough! When I visit services that have got it right, what do I see? How can that be replicated?

When I walk into a service that has got the safety culture right, I can feel it. People smile, they are welcoming, they look and act as one team and women and families are very clearly at the centre of care. They do not over-elaborate their successes. They tell the truth about what they are proud of, what difficulties they face and what solutions they are exploring.

Delivering safe care starts with feeling safe and supported as a member of the team. Feeling safe to escalate concerns, challenge poor behaviours and most importantly the ability to ask for help when it is needed. That team is not just midwives, it is the whole team: obstetricians, MSWs, neonatal teams, clerical staff, the list is endless and each and every one equally important. Teams that work on their relationships and listen and respect each other’s perspective make a difference. Most importantly they ARE together, whether that’s getting together over a cup of coffee or sitting down to discuss care pathways.

Safe care is about learning together. Learning and challenging the current evidence, learning new skills and practicing old ones. It’s about forensically exploring why things have gone wrong and trying out new ways of putting it right. I suppose this is what we would call an open and transparent culture.

The key to success is leadership. Not just people in senior roles but leaders throughout the organisation that consistently do the right things. This includes role modelling the right behaviours but also encouraging everyone to be curious about every aspect of their own practice, their ward, team, department, and service to satisfy themselves that everything is ok.

Strong leadership stops blame and does not hide. Leaders create the social glue that pulls everyone together in the uniqueness of the service and continues to support everyone to always think of doing the best they can.

There is so much good in maternity services and I absolutely know that by pulling together we can end this era of harm and negativity.