The Safer Births Programme made improvements to maternity care at MCHT Crewe over time. Key changes included implementing tools like SBAR for better communication, a buddy system for hourly CTG reviews, and a birthrate acuity tool for escalation. These helped increase teamwork and coordination. Outcomes included higher ratings for safety culture, fewer CTG misinterpretations, and decreased rates of low cord gases and postpartum hemorrhage. Lessons included involving staff earlier and maintaining momentum with continued initiatives to further normalize safe practices.

1. How the Safer Births Programme
made a difference
Mr Simon Cunningham
Acknowledgments to Denise Horne & Cath Murray
Developing Better Maternity
Care Conference
The King’s Fund, March 2012

2. Overview
• Background of the project & organisation
• Key issues & change of approach
• Timeline
• Outcomes & changes in practice
• Key lessons
• Future

3. Background
• The place MCHT Crewe and its surrounding areas
(Population of 300,000)
• Foundation trust in 2008
• 60 hour / week labour ward cover since early 2010
• Three levels of consultant involvement
• Four heads of midwifery & three GDM / ADD’s

4. The safer births initiative
• Decrease CTG
misinterpretation
• Decrease low cord gases
• Decrease PPH rates
• Better use of the maternity
information system

5. The safer births initiative 2.0
• Better teamworking
• Better communication
• Adoption of national tools for
patient safety

6. Manchester patient safety framework
• MaPSaF
• Maturity, culture & perception
• Teamworking domain scored B (reactionary)
• Ideas for service improvement
• Congruence with governance issues

7. Teamworking
• What defines your team?
• How easy is it to
communicate ideas ?
• Roles & goals
• Loafing versus labouring
• Topdown for direction.
Ground up for solutions

8. Initiatives
• Communication tools
• Buddy CTG system
• Birthrate acuity & NPSA intrapartum tools
• Communication of change
• Postpartum haemorrhage

9. SBAR
• Situation Background Assessment Recommendation
• Flattens the hierarchy
• Streamlines & standardises
• Promotes continuity
• Reduces frustration !!!

10. SBAR
• CHAPS used by a
cluster partner
• Ownership by staff
• Mandatory training
• Distributed throughout
care pathway

11. SBAR
• CHAPS used by a
cluster partner
• Ownership by staff
• Mandatory training
• Distributed throughout
care pathway

12. Birth rate acuity

13. Birth rate acuity & escalation

14. Birth rate acuity
• Embedding
• Escalation policy
• Audit
• Elective activity
• Low cord gases

15. Birth rate acuity
• Embedding
• Escalation policy
• Audit
• Elective activity
• Low cord gases

16. Buddy system
• Followed two root cause
analyses
• Hourly (first stage), 30 mins
(second stage)
• Reinforced K2 and
mandatory training
• Created environment for
discussion

17. Buddy system
It’s that Buddy time again!
A fresh pair of eyes…
On the hour, every hour

18. Buddy system
• Habit
• Ad hoc
• Guidance revised by LWC
• Not clearly
understood
• Drove it
• Not reinforced
• Directed to problem • All EFM
traces
• Rolling audit

19. Labour ward co-ordinators
consultancy day
10.00 Welcome and introductions
Overview and update on SBIN project
• 10.15 Agreeing purpose and expectations
• A day in the life of a Labour Ward Co-ordinator
Triumphs and tribulations
LWC as leader
• 11.30 Break
• 11.50 What’s my style?
How do I like to do things, how do I work
with others?
• 13.00 Lunch
• Introducing change and making it stick
Working with real issues identifying:

20. Labour ward co-ordinators
consultancy day
• “We have achieved more today
than we might in weeks or
months on the unit”
• “It has been excellent to spend
the day together - it is the first
time we have all been in the
same room.”
• “I think we have worked together
well - we have had different ideas
but have been able to agree
some good ways forward. It’s
good to get the feeling of working
as a team”

21. Outcomes
• MaPSAF: B/C into C/D.
• Reactive into bureaucratic into proactive
• Triage & induction areas made
• SBAR across the board
• Escalation policy works…
• Buddy system embedded
• Dissemination of guidance/practice

22. What went well
• Culture versus strategy
• Cluster days
• Consultancy days
• Core days
• MDT

23. Timelines

24. Momentum

25. Momentum

26. Next time we’d
• Involve more people sooner
• Board support
• Mentor sites
• Postpartum haemorrhage

27. How has ……?
• Look behind the headlines
• Creating a movement
• Pseudoteams
• Sell, buy, own
• Network
• MDT works

28. Moving on
• Shared decision making project
with AQUA
• Normality
• Antenatal care pathways
• Screening & fetal med
• Postnatal care & parentcraft
• Complex social care
• Bereavement & Post-traumatic
stress

29. • “You don’t reduce
caesarean section rates
with policies and
guidelines you do it by
changing the people”
• Professor James
Walker, first core
meeting at The King’s
Fund, October 2009.