This is the first blog in a series of four that looks at the success factors for improving clinical quality in maternity services - so mothers enjoy great care and staff enjoy their work. Here, I consider multidisciplinary team working that involves health care professionals, support staff and parents. To hear about the latest developments in maternity quality improvement, sign up for monthly maternity services news to your inbox.
What is multidisciplinary working and why do we need it?
Women need care from a range of health care professionals during their pregnancy. If those professionals spend time together looking at clinical outcomes and plan interventions to improve quality, the team can get to know one another, improve communication, agree direction and ensure changes made in one part of the service won’t adversely affect another part of that service. Health care professionals rely on support staff to make sure services run smoothly, in a clean environment and for the right information to be available at the right time. Including support staff in quality improvement work is therefore important if interventions are to be designed and implemented efficiently and effectively.
How can a multidisciplinary team work effectively?
The environment in which teams function helps teams operate effectively. Edmonson (1999) discusses the importance of psychological safety in effective team working. Psychological safety means that team members believe that no-one will be blamed or punished by other team members, who will help each other to achieve their goals. In this environment, team members are willing to ask for help, ask questions, forgive mistakes and work towards continually improving quality. This is particularly important in fast-paced work environments, such as maternity services.
Is there a role for parents?
Great progress in reducing infant mortality has been made by listening to parents. The sudden infant death rate (SIDS) fell from its peak of 2.3 deaths per 1,000 live births in 1988, to 0.3 in 2014 after researchers talked to parents and discovered risk factors. The factors were so simple, that the results were not believed at first (SETsquared 2006). Involving parents in maternity services improvement work can help find the simple changes that will make a big difference.
More recent case studies show how involving parents improves quality – including better communication with women, enhanced staff experience and increased smoking cessation referrals (NHS London Clinical Networks 2015).
How to involve parents in maternity quality improvement work
Kings Fund (2016) research shows that maternity services that involve parents to good effect use a mixed-method approach to feedback collection. That is, services pro-actively seek the views and opinions of parents as well as using national tools.
Building trust is key in local user engagement. There are three types of trust (Newell and Swan 2000 in Martin and Finn 2011) which tend to indicate effective user collaboration and knowledge sharing:
So how might this model for building trust in user engagement be applied in maternity services (given that the study looked at service user involvement in cancer genetics projects)?
Companion trust may be evidenced by:
- regular (at least monthly) meetings with the multidisciplinary team, for example, at clinical quality, MSLC (maternity service liaison committee), clinical network or service development meetings;
- being considered part of the team, for example, parent representatives are invited to team socials.
Competence trust could be demonstrated by parents being selected by a senior member of the clinical team - perhaps the risk management midwife or an obstetrician - on the basis of their ability to:
- make a positive difference to maternity services;
- understand and seek out multiple perspectives (from other parents and staff); and
- process complex and, occasionally, distressing information.
Commitment trust sees parents granted formal volunteer status, signified by:
- a job description (covering competencies and governance);
- regular discussion with a supervisor (this could be the clinical team member who selected them); and
- may claim subsistence and travel expenses.
When involving parents, how do you want them to feel?
One maternity service user – Emma Jane – blogs about two very different experiences of being involved in service improvement. How do you want your service users to feel?
At first I was quiet, overwhelmed by those around me…but I was determined to speak up. Yet when I did no one listened. I was talked over, interrupted and…told I had no idea what it is like to work in the system and how patients now expect too much...So I fell silent, my voice meant nothing.
Or like this..?
[At] every meeting I…felt welcome. I was listened to and was able to give…information about what is available…nationally as well as what it is…needed [from local services]...[I felt] part of the team... [At] every meeting the…[chair] would [say] they were lucky to have me there…For me, the emotional cost and physical cost was worth it because I was making a difference and my worth was appreciated.