Woman Centred Care and Maternity Care Pathways ..

1. Woman Centred Care and Maternity Care Pathways.. NHS Lanarkshire

2. ..What matters ?

3. Session Aims • Listening to what matters to our women and to the staff • Share our approach to maternity care pathways • Integrating patient safety, person-centred and effective care in our improvement approach • Sharing our improvement work and learning • Hearing from members of the multidisciplinary team who will share their learning

4. Who are we and how did we get here? • Jane Murkin -Head of Patient Safety • Stacey Rooney - Clinical Quality Manager • Maureen McSherry - Consultant Midwife • Clare Willocks - Consultant Obstetrician • Cheryl Clark - MCQIC  Champion midwife • Ann MacLeod -Mother

5. Jane

6. Ann

7. Maureen

8. Clare

9. Stacey

10. Cheryl

11. What matters to us as a team • What matters to women , babies and their families- to get the best possible start in life • Safe, effective, reliable care “every patient every time” • Person-Centred care ; “nothing about me without me” • Ann matters, Kian matters • What matters to staff • What matters to you !

12. Pilot- What matters to me in maternity • To understand what matters to our mums, dads, partners and staff and what they feel matters to the baby • Printed the postcards and labels in house to test for one week

13. Who we asked?

14. Mums

15. Dads/ Partners

16. Maternity coordinators • Ward managers • Staff midwives • Clinical Support Workers • Breast feeding support workers • Physiotherapists • Hearing screening • Domestic staff

17. Obstetric, Theatre and Anaesthetic staff

18. Pharmacists

19. Ward Clerkess

20. Baby

21. When we asked • On admission for elective caesarean sections, induction and early stage labour • After the safety brief or during the course of the shift

22. What we asked • 3 things that mattered to them for that care episode • 3 things they felt mattered to the baby for that care episode

24. How we assessed the “data” This is not data for analysis, it’s what matters to families coming through our unit and the staff that are caring for them. Collated, qualitative analysis

25. What matters to Mums and “Dads” ? • Kind, friendly and helpful staff • Clean rooms • Be kept informed • Have things explained • Be listened to • Treated with courtesy and respect • Calm atmosphere • Dad/Husband/Partner is present and made welcome, feels involved • Good aftercare • Respect my choices • Pain relief

26. What did Mums and Dads tell us matters to baby? • Delivered safe and well • Kept warm • Feeding well • Clean environment • Close to mum and dad • Regular checks • Skin to skin / bonding • Calm environment • Kindness • Cuddles • Friendly staff • Home as quickly as possible

27. What matters to staff? • Mums delivered safe and well • Effective communication/handover • To feel valued, respected and appreciated • Meal breaks on time • Provide best possible care • Supportive environment • Not being interrupted when providing care • Working well as an MDT • Parents made welcome • Cleanliness of ward environment and staff • Team morale • Efficiency • Continuity of care • Time to properly prepare • Correct equipment available • Value my opinion • Optimal birth experience

28. What did staff tell us matters to baby? • Safe delivery • Warm • Feeding well • With parents • Skin to skin /bonding • Parents fully informed before discharge • Thorough checks • Not traumatised after delivery • Breastfeeding • Delayed cord clamping • Safe and secure • Not admitted to NNU

29. What now? • How do we use this approach going forward? • When do we ask / how often? • How do we use the information? • Use it to provide a person centred experience alongside our pathways of care • Key themes – what do we already do well, and what improvement opportunities do we have?

30. Ann’s story

31. What matters to Ann Antenatal Birth Experience Control Natural birth Natural third stage Knowing herself Keeping Calm Being listened to and respected Ian How she was spoken to Continuity of care Counselling service Clinical understanding -understanding the physiology of labour and what happened • Continuity of Care • Choices -Shared decision making ; vaccines in pregnancy, Individualised Risk Assessment for PPH

32. Kian matters

33. Maternity Care Pathways

34. Current Situation – What policies shape our practice MCQIC • Positive patient experience • Safety – the reduction of risk of unnecessary harm associated with health care to an acceptable minimum (WHO –ICPS 2009) Person centred care Care which is responsive to individual personal preferences, needs values and assuring that patients guide all clinical decisions KCND Principles • Physiological birth should be explicit in midwives work philosophy and approach • Care supported by evidence • Continuity of care/carer encouraged • Promotion of woman’s self belief/confidence around normal birth • Provide a calm positive environment

35. Risk KCND pathway- Ann • Age 43 years • 4th pregnancy • Mum & Baby assessed– no unstable lie and baby not small for dates • Fetal wellbeing reassuring • Deemed not in labour – no unnecessary VE • High blood pressure • Unsupported birth – husband sent home/ no one-to-one care • Physiological birth all stages • Listen to woman – assessment not carried out – but now inpatient • Requests pool use –guidelines states BP too high • Age and parity both risk factors for PPH • Potential increase anxiety with no emotional support at crucial stage in labour- interferes with normal physiology - high levels stress hormones and low levels oxytocin • Visiting policy – if not in labour partner requested to leave maternity

36. We need to listen to women and our staff for sustainable improvement in effective, safe and reliable maternity care

37. Last Slide • Thank you to the team • What have we heard? • Power of the story and using experiences to drive improvement • Testing improvements to achieve safe, effective and person centred care • Next steps on our local improvement journey • What are your take away messages?

39. Thank you for listening and participating over your lunchtime !