Angela Cunningham is our Midwifery Clinical Lead for our organisation. Angela has practised as a midwife for over 38 years in both Scotland and England. In this blog Angela explains how quality improvement has supported real changes for mothers and babies in Scotland.

When I first entered the world of midwifery as a student in 1981 it was accepted that things didn’t always go as planned. It was a high risk area of work, we did our best but sometimes things just went wrong!

Now, 38 years later, I was delighted when I heard that ‘safe maternal and newborn care’ was going to be the theme of the World Health Organisation (WHO) patient safety day on 17 September 2021. It really made my year. I know that may sound strange, however, improved safety and care are what I’ve aspired to throughout my midwifery career. Safe and respectful childbirth should be the right of every woman.

Improved outcomes

In Scotland through the Scottish Patient Safety Programme Maternity and Children’s Quality Improvement Collaborative (SPSP MCQIC) we have worked hard to improve outcomes for babies, children and mothers. Our work in the area of stillbirth is recognised as world leading. From the inception of the programme in 2013, MCQIC has supported NHS boards to understand their local data and introduce changes to support efforts to reduce stillbirth rates. Don’t get me wrong, we still have lots of work to do. However, as the Midwifery Clinical Lead I am really proud to be part of a programme which has helped services make changes which mean more mothers taking their healthy babies home to start a new family.

The introduction of the Scottish Patient Safety Programme gave maternity staff the opportunity to run small tests of change through the Model for Improvement and Plan Do Study Act (PDSA) process. These incremental changes have had a major impact on outcomes, giving staff permission to make changes which have improved outcomes for families across Scotland. Applying Quality Improvement (QI) methodology has helped to develop a consistent approach to service delivery at local and national level. It has improved communication between teams and more importantly improved the quality of the care and advice given to women and families. When I speak to frontline staff I feel humble when they tell me stories of how QI is working in practice, how they are using it and the improved outcomes for women and families.

Engaging with the clinical community

When we started out on this quality improvement journey I asked myself how are we going to engage with the clinical community? How would they feel and would they be overwhelmed by what we were trying to achieve? The answer was and still is “one mother, one baby, one family” at a time. This is the message we delivered. Individual staff members in maternity services could see how they could make a difference and they have risen to the occasion.

Safety is paramount in maternity services. Across the world too many women and babies are still dying in pregnancy and childbirth. Many of those dying in pregnancy and childbirth are only children themselves.  We all have a responsibility to do everything we can to keep them all safe. Highlighting this on 17 September is another step in the right direction. We are all still on this journey together. 

Fast paced and making a difference

Working in Healthcare Improvement Scotland is fast-paced and exciting. I’m part of the team that supports continuous improvement and re-design services for the better in healthcare settings. My training with patients and clinicians gave me transferable skills in negotiation and communication so I can engage in discussions with the same clinicians I am working with now. The training, coaching and mentoring support that I have received since I started has been invaluable and it has helped me become more confident in my role. If you want to work in a fast-paced and exciting team where you can make a huge difference in improving healthcare services, becoming an improvement advisor is the first step towards that goal.

Angela Cunningham is our Midwifery Clinical Lead.

More information

More examples of the work of SPSP MCQIC and resources to help make maternity care as safe as possible are available on our website: