Recently in Scotland there has been renewed focus on improving the quality of care for women, babies and children. Deservedly so, as this is an important area of care that can be either incredible or devastating for families. The publication last year of The Best Start, the Scottish Government’s five-year plan for maternity and neonatal care in Scotland, brought this to the fore and highlighted the importance of quality improvement methodology as a way of supporting the service changes proposed.
The Maternity and Children Quality Improvement Collaborative (MCQIC), part of the Scottish Patient Safety Programme, is a key vehicle for delivering this change, with its aim of reducing avoidable harm to provide safe, high-quality care for women, babies, children and families in Scotland.
“At NHS Lanarkshire the introduction of a warm bundle of care (a series of steps to reduce hypothermia) for babies at birth led to a 45% reduction in term admissions (babies born between 37 and 40 weeks’ gestation) to the neonatal unit in the pilot ward.
Now spread to all maternity wards in NHS Lanarkshire, this has so far resulted in an overall reduction in term admissions by 18%.”
We do this by supporting front-line staff to make improvements, where necessary, to the care they deliver. MCQIC has helped midwives, obstetricians, neonatologists, paediatricians and nurses to develop their skills in quality improvement methodology to bring about sustained improvements to care. For example, at NHS Lanarkshire the introduction of a warm bundle of care (a series of steps to reduce hypothermia) for babies at birth led to a 45% reduction in term admissions (babies born between 37 and 40 weeks’ gestation) to the neonatal unit in the pilot ward.
Now spread to all maternity wards in NHS Lanarkshire, this has so far resulted in an overall reduction in term admissions by 18%. Meanwhile, a few miles west, in NHS Greater Glasgow and Clyde a team tested new processes that resulted in a 78% reduction in ventilator-associated pneumonia, a healthcare-associated infection in paediatric intensive care units.
“Our team provides improvement advice to front-line staff across Scotland, drawing on the expertise of our four clinical leads and the support of our project team. We live and breathe quality improvement methodology; in our roles, we are able to support improvement projects being delivered by front line staff in all NHS boards in Scotland.”
We are proud to say that Cheryl Clark and Lesley Macfarlane, who are now associate improvement advisors in the national MCQIC team, were part of the teams that delivered these key improvements. Our team provides improvement advice to front-line staff across Scotland, drawing on the expertise of our four clinical leads and the support of our project team. We live and breathe quality improvement methodology; in our roles, we are able to support improvement projects being delivered by front line staff in all NHS boards in Scotland.
These local projects are a snapshot of the incredible work taking place across Scotland. It cannot be stressed enough how, when amalgamated, these small projects can bring about huge impact. Thanks to all the local projects in teams up and down the country.
“Over the years we’ve noticed a cultural change; a shift in mindset, a building of will. Front-line staff feel empowered to make changes that improve the quality of care.”
Aggregated national successes from the MCQIC programme since it began in 2013 include:
- a contribution to a 22.56% reduction in stillbirth and a 17.3% reduction in neonatal mortality since 2014 (quarterly NRS data)
- 12 out of 14 NHS boards implementing a standardised paediatric early warning score
- local reductions of between 40% and 50% in postpartum haemorrhage (heavy bleeding after birth).
Some of these changes have been supported by the collaborative development of tools or packages of care with the communities, such as the preterm perinatal wellbeing package, a collection of interventions that help reduce mortality and morbidity. But a huge success for MCQIC has been facilitating improved teamwork and communication across all workstreams, through the national focus on SBARs (which stands for Situation, Background, Assessment, Recommendation – a technique which helps prompt and appropriate communication), surgical briefs and huddles. Now every hospital in Scotland is using these tools, resulting in safer care.
Over the years we’ve noticed a cultural change; a shift in mindset, a building of will. Front-line staff feel empowered to make changes that improve the quality of care. We’re proud of the work that’s been done so far and of every step we’ve taken to make care safer. We can achieve even more with these local teams in the coming years as we focus on reducing key areas of harm in maternity, neonatal and paediatric care.
Bernie McCulloch is an Improvement Advisor with the Maternity and Children Quality Improvement Collaborative part of the Scottish Patient Safety Programme.
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