Angela Cunningham is our Midwifery Clinical Lead for our organisation. Angela has practised as a midwife for over 39 years in both Scotland and England. To mark International day of the Midwife, Angela explains how quality improvement continues to support real changes for mothers and babies in Scotland. Angela encourages all staff working in maternity services in Scotland to engage with quality improvement. Our organisation offers virtual visits, informal meetings and a range of webinars, all aimed at improving outcomes.

As a student midwife in the early 1980’s, and following that practicing as a midwife, we really did not have access to the levels of data immediately available to us now. By the time we had access, the data was often two to three years out of date. We all thought things had improved, we were doing it differently and doing it better. However, we had no up-to-date data to support these claims.  

Now we have access to up-to-date data, we can track what is happening in the system and we can put in place systems and processes, tried and tested, by using the PDSA (Plan Do Study Act) methodology.

Safe and respectful childbirth should be the right of every woman. This is never more important than now, following the publication of the Ockenden report, which criticises the care delivered to women and families. We all need to hold up that mirror and ensure we are the best we can be and offer true informed consent to the users of the services.

Improved outcomes

In Scotland, through the Scottish Patient Safety Programme’s Maternity and Children’s Quality Improvement Collaborative (SPSP MCQIC), we continue to work 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. As always this is ongoing work. In the NHS boards, colleagues are passionate regarding our aim to further reduce the stillbirth rate in Scotland. As the Midwifery Clinical Lead for Healthcare Improvement Scotland, working with the multidisciplinary team, 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. When all is said and done this is our purpose at Healthcare Improvement Scotland.

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 hear stories from frontline staff about the difference they have made to the families they work with it makes me very proud that in the background we in HIS are contributing to this through #SPSPMCQIC

Engaging with the clinical community

Everything we do is based on improving outcomes and we do this by engaging with frontline clinical staff. Safety is paramount in maternity services. Across the UK and the world, too many women and babies are still dying in pregnancy and childbirth. For some of those dying in pregnancy, experiencing a stillbirth, a neonatal death or a baby harmed at birth, it is due to systems and process failures and human error. We all have a responsibility to do everything we can to learn from things that go wrong, listen to the parents involved, as they are closest to the process and know the timelines of what happened to them, and support staff through the learning from adverse events process in a supportive environment.

Fast paced and making a difference

Working in Healthcare Improvement Scotland has been strange over the last two years. However, we have risen to the challenge, engaged without colleagues remotely and were involved in the implementation of the home monitoring and Near Me technology. It was amazing how quickly using the PDSA methodology that we could implement a change safely and rapidly. I’m part of the team that supports continuous improvement and the re-design of 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.

I would recommend working in Healthcare Improvement Scotland to any colleagues. No matter what your background or previous experience, we can learn from you and you can learn from us.

‘All share, all learn’ really is our moto.

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: