Corinne Love is the National Obstetric Clinical Lead for the maternity strand of the Scottish Patient Safety Programme. We spoke to her about how NHS Scotland is spreading quality improvement in maternity services.
Tell us about the national approach Scotland is taking to improving maternity services?
The Maternity and Children Quality Improvement Collaborative (MCQIC) is a three year collaborative, running from March 2013 – March 2016. It’s part of the Scottish Patient Safety Programme (SPSP) which drives improvement across the whole of NHS Scotland, led by Healthcare Improvement Scotland (HIS) and funded by the Scottish Government.
MCQIC oversees all of the maternity, neonatal and paediatric improvement work. Our overall aim is to improve outcomes and reduce inequalities by providing a safe, high quality care experience for all women, babies and children in Scotland.
Specifically, within the maternity strand, we’re aiming to reduce avoidable harm by 30% and increase the percentage of women satisfied with their maternity care to over 95%. You can read our detailed aims here.
How does the collaborative model work?
To date SPSP has taken a collaborative approach based on the Institute for Healthcare Improvement’s (IHI) model for achieving breakthrough improvement.
It’s structured around a programme launch followed by a series of learning sessions which bring together individuals from the whole maternity community. In between these sessions there are periods of improvement work using PDSA cycles (plan, do, study, act) to test and implement change. These ‘action periods’ are led by local teams and boards with detailed support from the HIS team.
What success has the collaborative achieved so far?
National aggregated data has only started to become available recently, but it’s encouraging and we are progressing well towards our national improvement aims.
National Records Scotland (NRS) data shows that there has been a 10.6% reduction in the annual national stillbirth rate from 2012 to 2013, an 11.5% reduction in the annual neonatal death rate from 2012 to 2013, and 93% of women are now being offered carbon monoxide monitoring at booking.
2013-14 data for stillbirths and neonatal deaths should be available shortly but suggests further reduction has been achieved.
Have you found it easy to engage staff in a national programme?
The improvement we’ve seen within the maternity programme so far has been largely attributed to our funded midwifery champions having dedicated time, which has enabled them to facilitate improvement within multidisciplinary maternity teams at a local level.
The maternity community is relatively small within Scotland and the programme has provided a tremendous networking opportunity for obstetricians as well as midwives. In addition, the learning sessions have allowed a greater range of enthusiastic staff to come together and learn and share, all leading to greater building of capacity and capability locally and improving engagement.
What’s been your biggest challenge?
As always there have been challenges around data collection and measurement, as there are many different IT systems in place throughout Scotland. However, using PDSA cycles and rapid cycle audit (reviewing five sets of case notes per week) has been effective.
The structured measurement strategy and regular reporting built into the programme mean that locally, units and boards are able to share current data to aid ongoing improvement. This is also allowing the MCQIC team to start to compile national data.
One of the positive challenges has been containing the enthusiasm! The networking opportunities created have been recognised beyond HIS, and the collaborative has been approached regarding other Scottish and UK areas of work.
Tell us more about the maternity champions?
The maternity champions are all midwives working in local settings. They are funded by Scottish Government to have dedicated time – one or two days a week depending on the size of the maternity unit – to lead on the maternity strand of the programme locally. This is helping to build improvement capacity and capability locally, support local delivery of the programme and ensure reliable monthly data submission.
We recognised early on that medical buy in would also be crucial. So there are also local obstetric and anaesthetic champions. These individuals are not externally funded but had all expressed interest in the improvement work. They provide a multidisciplinary link between SPSP and the local teams as well as providing medical and midwifery support locally.
And then of course there are also national clinical leads for obstetrics (my role) and for midwifery, who also have funded time.
What are the biggest opportunities to running a national programme?
The networking and collaboration the programme has provided within Scotland has Scotland’s maternity community talking to each other in a way and on a scale I have not witnessed before.
Seeing change and improvement occurring at a national level has been amazing and is unprecedented within maternity services in Scotland. The strong infrastructure HIS has created has underpinned the whole process. This has allowed us to reduce variation in practice on many measures and to agree national standardisation in practice in other areas.
The English NHS is conducting a national maternity review at the moment, what do you think they could learn from how Scotland is doing things?
The infrastructure supporting the programme has been hugely influential in the scale and speed of the progress we’ve achieved in Scotland. Scotland is a much smaller nation than England and the scale of the support required is different, but support for a similar infrastructure, even at strategic clinical network level, could only be beneficial.
Health care systems can always learn from each other. In Scotland a significant steer early in the collaborative came from IHI and their perinatal community work. However, it became clear that aspects of our health care systems are different and issues pertinent in the USA were not significant issues in Scotland. It is likely given the similarities between the UK nations that our safety issues will be similar, and that reducing variation across the UK within maternity settings, where appropriate, would improve safety.