The maternity unit at a large acute trust
Verita was commissioned by the maternity unit at a large acute trust to support the development of a protocol for the handling of births where the woman’s birth preference lies outside trust guidelines. Differing opinions between midwives and obstetricians about how to manage such cases had created a dysfunctional working environment. The midwifery team took a pragmatic approach to try and accommodate women’s wishes, explaining risks and providing support to minimise risk. The obstetricians took a more risk averse approach, concerned about their own professional accountability in the event that a guideline is not followed and something goes wrong.
The trust was alert to the issue of poor relationships between doctors and midwives potentially compromising patient care as identified in the report into Morecambe Bay Hospital.
Verita provided external support to the obstetricians and midwives to enable them to jointly agree a protocol for these births.
The work was carried out in three stages:
- Focus groups: facilitated exploratory meetings with the trust’s midwives and obstetricians as separate groups. The purpose of these sessions was to give Verita a clear understanding of the status quo and explore any barriers to collaborative working. A total of 41 staff comprising junior midwives, midwifery managers and consultant obstetricians attended the focus groups.
- Training on legalities of informed consent: two half day joint training sessions for midwives and obstetricians. The purpose of these multidisciplinary sessions was to encourage interactive discussion and the opportunity for different professionalisms to share their experience and understanding. Whilst the content was adapted to accommodate feedback from the exploratory focus groups the training also covered the legal, regulatory and professional framework applying to informed consent, communicating risk, shared decision making and demonstrating good practice. Approximately 40 staff attended the two training sessions.
- Protocol development: working with nominated representatives from obstetrics and midwifery to develop an agreed trust protocol for managing births outside trust guidelines. The development of the protocol included the establishment of a working group to manoeuvre the stages of change management.
Findings and recommendations
Our work coincidentally led to the trust following two recommendations made in the National Maternity review. The first covers personalised care that is centred on the woman, her baby and her family. This care is based around their needs and decisions, where they have genuine choice and are informed by unbiased information.
The second recommendation we have been working on covers multi-professional working, breaking down barriers between midwives, obstetricians and other professionals to deliver safe, personalised care for woman and their babies.
The National Maternity Review sets out a vision that ‘those who work together should train together… so that they understand and respect each other’s skills and perspectives.’
We have helped the trust achieve this by providing multi-professional training. Course evaluation received from 33 attendees has been provided to the commissioner and was positive. Asked the question, ‘did this course meet your expectations?’ 26 respondents said ‘yes’: seven respondents said ‘it exceeded them’.
This approach adopts a key finding from the Morecambe Bay report, referred to in the National Maternity review; establishing the right culture needs leadership and commitment from everyone: individual health professionals and teams as well as senior management. Above all, it requires individuals to operate as part of a team across professional disciplines.