Making midwifery care the best it can be

Gill Walton has just started in her new role as chief executive and general secretary of the Royal College of Midwives. She was previously Director of Midwifery and Maternity at Portsmouth Hospitals NHS Trust, where she led on many quality improvement projects, including the My Birthplace app, which was supported by a Health Foundation Shine 2012 award. We spoke to her about her passion for making maternity and midwifery care the best it can be.

When did you first start to get interested in quality improvement?

It was when I was doing action research as part of my clinical doctorate. Unfortunately I was so busy at work I ran out of time to finish my doctorate, but the last project I worked on was about how to help women make informed choices about their place of birth (given that the Birthplace 2011 research had just come out). A colleague told me about the Health Foundation Shine awards and I saw an opportunity to finish the work, developing a decision-making app that provided women with evidence-based information about birthplace choices.

Tell us more about My Birthplace and how the work has spread?

Even though there are a lot of options for where to give birth in Portsmouth, a large number of women were ending up in the obstetrics unit, despite being low risk. We found that women were either choosing their place of birth early on in pregnancy, based on a very loose conversation, or just not making a decision at all. So we wanted the app to facilitate better conversations about the options to help women make informed choices.

Feedback showed women really liked the app. Using it alongside an ‘ask three questions’ card (a handout that encouraged women to take the lead in asking questions about options, risks and benefits) really increased the number of women at 36 weeks pregnant who felt confident of their decision about where to give birth. The app also helped midwives understand the evidence about different settings, meaning they were better able to support women to make decisions.

We got some additional funding from the Wessex Clinical Network to roll out My Birthplace further, so now all the trusts in Wessex are using a localised version. It’s also being adopted by other trusts and is being used as far away as Tayside.

I’m also really proud that My Birthplace is mentioned in Better Births, NHS England’s plan for modernising maternity services.

The Southampton, Hampshire, Isle of Wight and Portsmouth local maternity system is now a choice and personalisation pioneer for Better Births and as part of that they’re adding another module to the app called My Maternity. This will cover the other choices women have across the maternity pathway, so could be really powerful.

How have you tried to inspire others to focus on improving care?

Well as Director of Midwifery at Portsmouth, quality improvement (QI) was a big part of my role. Within maternity services we ran a modernisation programme called Nurture, and My Birthplace sits among a whole range of great work I’m proud to have overseen. The programme was made up of lots of small projects, all led by staff from the bottom up, using plan, do, study, act (PDSA) cycles to try out new ideas.

There’s a really positive culture of QI in Portsmouth, not just in maternity but across the whole trust. I was lucky to work alongside some really knowledgeable people, including our QI fellows. I was on the trust’s QI steering group and it really helped that I could bring the hands-on experience I gained developing My Birthplace. But mostly I saw my role to influence at a strategic level, spreading positivity about the benefit of using improvement methodology, and also signposting people to organisations that can help put ideas into action.

Having ongoing contact with the Health Foundation since the Shine award has given me opportunities to speak at conferences and spread our learning. The Foundation is great at creating that ripple effect – they keep engaging with people after the funding has finished, so that they in turn can help and inspire others to improve.

And finally, tell us about your new role and the opportunity to further encourage quality improvement?

Well you’ve caught me at the end of my very first week in post at the Royal College of Midwives. QI is absolutely central to the business of the college. We’re striving to make care better and ensure midwives have the tools to do that in the best way. I’ll be bringing all my experience so far to the role. Getting this right for our members is the biggest and most exciting challenge I’ve ever taken on.