World Patient Safety Day 2021: Yorkshire Quality and Safety Group
The third annual World Patient Safety Day takes place on 17th September 2021. Established by the World Health Assembly[1], the day is all about increasing public awareness and understanding and working towards global solidarity and action on patient safety. Each year, the World Health Organization (WHO) selects a theme to highlight a priority area for action. This year’s theme is ‘Safe maternal and newborn care’, with the WHO encouraging us to ‘Act now for safe and respectful childbirth!’.
Every day 810 women and 6700 newborns lose their lives. While the greatest burden of these deaths is in low- and middle-income countries, confidential enquiry reports in the UK highlight that maternal mortality is higher in older women, those living in the most deprived areas and amongst women from ethnic minority groups[2]. Most of these deaths are preventable through the provision of safe, effective and high quality care. Although coverage of evidence-based interventions such as antenatal care and skilled birth attendance have increased rapidly, the quality and safety of care provided to mothers and babies is often lacking. Reducing the safety risks during pregnancy and around the time of birth is critical for maternal and newborn survival.
In this blog we outline some of the work being carried out by researchers in the Yorkshire Quality and Safety Research group (YQSR), based at Bradford Royal Infirmary, which contributes to our understanding, and implementation, of safe maternal and newborn health care and services. We work closely with colleagues in the Patient Safety Collaborative, and the Improvement Academy, to facilitate translation of research findings into a range of initiatives to improve safety for mothers and newborns. Read their World Patient Safety Day blog here.
Strong teams lead to safer births
Rising birth rates and increasing complexity of births in UK maternity services has led to increasingly multi-disciplinary teams of healthcare staff, particularly during childbirth. Failures in teamwork and communication continue to be identified as substantial contributors to compromised patient safety in both research and in high profile inquiries into maternity services3 4.
Dr Siobhan McHugh (Research Fellow, YQSR Group) explored the use of video reflexive ethnography (VRE) as a tool for the improvement of communication at the multi-disciplinary clinical handover on labour ward. Using video footage of the handover captured in situ to prompt discussion, multi-disciplinary staff groups were prompted to collaboratively identify areas for change or improvement, and ideas to address these areas. Siobhan has worked closely with two local maternity units (St. James’ Hospital, Leeds Teaching Hospitals NHS Trust and Bradford Royal Infirmary, Bradford Teaching Hospitals Foundation Trust) supporting them to use VRE to improve the multi-disciplinary handover on labour ward. Both projects resulted in staff-led changes to the structure of the handover. For the team at St. James’ Hospital this meant re-designing the handover to meet the different needs of obstetric and theatre teams better, ensuring theatre staff felt better prepared for any emergent safety concerns. For the team at Bradford Royal Infirmary, the work led to re-designing the handover to ensure multi-disciplinary input was welcomed, rather than a single one-way flow of information, allowing for more extensive discussion and awareness of emergent safety concerns or risk. Staff at both sites also reported improvements in clinical confidence, timely escalation of high risk cases, staff well-being and multi-disciplinary team culture. You can find out more about Siobhan’s research on Twitter (@YH_PSTRC, @yqsrdotorg, @skmc84). She has also presented a short snapshot video on her use of VRE in healthcare improvement which is available here.
Establish a safety culture in which healthcare workers are not afraid to speak up
Maternity is a high-risk environment and adverse events can have an impact on the affected women, partners and/or families and the midwives, doctors and others involved. An important element in managing the aftermath of these events is disclosure. Dr Raabia Sattar (Research Fellow, YQSR) focused on this topic for her PhD, specifically focusing on the support needed by healthcare professionals to do disclosure well.
The systematic review, conducted as part of Raabia’s PhD, highlights key elements of disclosure that are valued by patients. These include relevant information about the adverse event, accountability and an apology, and commitment to preventing future recurrences of the event. The review also found that health workers face a number of barriers when trying to disclose events to patients. To address this, Raabia and colleagues have developed a disclosure training workshop and top tips on how to do disclosure, hosted on our second victim website.
Led by Professor Jane O’Hara, the Patient and Family Involvement in Serious Incident Investigations (Learn Together) project aims to co-design guidance to support more meaningful involvement of patients and their families in serious incident investigations following adverse events in healthcare. The PFI SII team have worked with patients, families, healthcare staff, investigators and policy makers to co-design guidance to sit alongside Trust investigation policies. Starting in October 2021, the team will work with four participating NHS Trusts and the Healthcare Safety Investigation Branch (HSIB), to test this guidance during serious incident investigations. With the HSIB, the PFI SII team will focus specifically on investigations following serious adverse events during active childbirth. The aim of the guidance is to support investigators to more meaningfully involve patients, families and healthcare staff in investigations to enable better learning following healthcare harm.
Build trust, and engage and empower all women
Dr Gemma Louch (Senior Research Fellow, YQSR) and colleagues have been reviewing the evidence on patient safety for people with learning disabilities in acute hospital settings. A key finding in their recent scoping review, was that women with learning disabilities are more likely to experience complications of pregnancy and birth, including pre-eclampsia, pre-term birth, caesarean birth and small for gestational age babies. The NIHR, along with other national policy and funding bodies, recognises the lack of evidence about how maternity services are experienced by parents with learning disabilities. Gemma and colleagues aim to address this research gap with future research on how maternity services support parents with learning disabilities to identify what improvements are needed.
Setting and implementing global standards for safe and respectful maternal and newborn care
Dr Helen Smith (Senior Research Fellow, YQSR) has been committed to improving quality and safety of maternity care throughout her career and has valued the opportunity to work with WHO on guidelines that set standards for maternal and new-born care. WHO’s guidelines aim to promote health, prevent harm, and encourage evidence-based clinical practice and policy. Helen has worked with WHO’s Department for Maternal, Child and Adolescent Health and Ageing on guidelines for health promotion interventions for maternal and newborn health, interventions to manage health complications of FGM, home-based records for maternal, newborn and child health, implementing Maternal Death Surveillance and Response (MDSR) and postnatal care (forthcoming).
Supporting policy makers and health workers to implement safe and effective interventions requires just as much if not more effort than producing the recommendations. Helen has a special interest in implementation of safe, effective and respectful childbirth care. She helped set up the Better Births Initiative which had strong regional reach in Africa, and more recently has worked on factors that affect implementation of interventions for maternal and newborn health. Helen has recently been working with the WHO team to prepare a new implementation toolkit alongside the forthcoming postnatal care guidelines. The toolkit will help countries to adapt the recommendations to their context, update their policies, and identify factors that are likely to influence implementation of safe and effective postnatal care interventions.
We hope this blog has given you an indication of the research conducted within YQSR. As a multidisciplinary group we are committed to conducting high quality research on NHS and patient priorities, across a range of specialities including maternal and newborn health. We develop and evaluate innovative solutions to patient safety problems and deliver research that makes healthcare safer. We work closely with the Improvement Academy to facilitate translating research findings into practice. You can read more about their work to support high quality, safe maternity care here.
Written by: Dr Helen Smith (Senior Research Fellow) and Dr Siobhan McHugh (Research Fellow), Yorkshire Quality and Safety group
[1] The WHA is the decision-making body of WHO; held annually in Geneva and attended by all WHO Member States.
[2] https://www.npeu.ox.ac.uk/mbrrace-uk/reports
4 https://www.donnaockenden.com/downloads/news/2020/12/ockenden-report.pdf