It's a win-win for families and safe care
Working cooperatively to face challenges
The ihub co-designed the content and delivery of its Maternity and Children Quality Improvement Collaborative (MCQIC) programme with NHS boards to align priorities locally and nationally.
We recognised that NHS boards were facing challenges in participating and delivering the original programme content due to limited capacity, so we used a partnership agreement approach to redesign the MCQIC programme.
This resulted in reinvigorated engagement and improved outcomes for mums, babies, children and their families.
This story demonstrates the importance of working cooperatively with key stakeholders to enable long-term, sustainable change, and that there are always new ways to engage and deliver quality improvement (QI) nationally while continuing to reflect local priorities.
Reduced engagement and participation
MCQIC was established in 2013 with the aim to reduce avoidable harm to mothers, babies and children.
However, in 2017, engagement and participation from NHS boards had reduced with fewer data submissions, lower participation rates in learning opportunities and recurring feedback from NHS boards that competing priorities meant that limited QI funds and local resources could not always be focused on MCQIC. We needed to reverse this decline.
Because we had an extensive programme this led to different NHS boards working on different priorities. This made it difficult to aggregate data to demonstrate the national impact of the programme. The NHS boards also told us that the programme felt overwhelming.
Identifying local priorities together
Our first step was to identify national priorities by collating and analysing qualitative and quantitative data on QI activity across Scotland. This helped us to rationalise the content and create a set of national core priority measures. Across the programme, the total number of measures for NHS boards to work on were reduced from 120 to 40.
Inspired by Stephen Covey's win-win agreements from the book The 7 Habits of Highly Effective People, we then set out to establish bespoke partnership agreements with each NHS board. Our aim was to create a mutual commitment to improve day-to-day practice within the unique culture and context of each NHS board. Buy-in and engagement were crucial to the success of the agreements, so we adopted a two-pronged approach. We discussed it with front-line staff and management to ensure engagement from everyone involved.
The MCQIC team assisted NHS boards to identify local priorities by providing explanatory briefs and templates. To make sure that we had high-quality and effective partnerships, we met with the NHS boards to discuss each agreement. Several follow-up discussions took place to finalise these.
Each partnership agreement outlined the desired results and identified the resources and improvement support required to achieve these. Since the programme is ongoing, progress is monitored through a biannual self-assessment process. There is also a clear escalation process if the agreement is not working for either side.
Fewer measures, demonstrating impact
All 14 territorial NHS boards in Scotland welcomed and participated in this approach. This means we:
- ensure a shared and agreed understanding of challenges and opportunities,
- make best use of staff,
- avoid duplication and waste in the system, and
- facilitate best value to the mums, babies, children and their families using the services.
The NHS boards continue to review and analyse their progress, and involve more local staff in QI activity which helps inform any next steps for improvement.
In fact, the process provides a lever for many discussions to happen within NHS boards at all levels. Feedback comments include:
'It took the focus off data and on to improvement.'
'Thank you for the valuable, honest discussion, we have really welcomed the positive, supportive challenge.'
'We wondered if it was scrutiny or criticism (why do we need a contract?), but it wasn't like that at all. It felt different; supportive.'
Scaling back the programme content and allowing NHS boards to choose which priorities to work on, reduced the burden when submitting data.
The result was more data submissions:
- 19% increase in paediatric submissions since June 2018,
- 19% increase in neonatal submissions since August 2018, and
- 36% increase in maternity submissions since September 2018.
This increase in data submissions against fewer measures enabled us to better demonstrate impact across the whole country.
An example of our impact so far is the contribution MCQIC made to reduce the national stillbirth rate. In collaboration with other national initiatives, the Scottish national stillbirth rate has reduced by 23% since 2013. This means approximately 190 more babies went home safely between 2013 and 2018.
Another example of our impact at a national level is that 12 of the 14 NHS boards delivering paediatric care in Scotland now use the national Paediatric Early Warning system (PEWS).
PEWS is used for the early recognition and management of sick children which is crucial to ensure they receive the best care. Historically, there were multiple versions of early warning scores in use across the country. This meant that different NHS boards used different systems and this could lead to confusion. Particularly when children were being transferred to different hospitals or when staff moved to different paediatric units. MCQIC led the work to develop and implement a standardised approach across Scotland ensuring continuity of care. The Scottish Ambulance Service also uses this standardised early alert system.
The MCQIC team's working relationships with the NHS boards has been significantly strengthened during the redesign process.
An understanding of, and trust in, the role that the MCQIC programme plays has increased, producing a clearer appreciation of the commitments on both sides. We are able to provide more focused, valuable support to the NHS boards.
Across Scotland, QI efforts are now focused on the areas of care where there is greatest harm to mothers, babies, children and families.
There is more information on the MCQIC web pages.
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