Vinice Thomas: The push for improvement in maternity care

Substandard care within maternity services remains a high profile issue. It seems that every month there is news coverage about failing hospitals, avoidable maternal deaths, and below optimum care provided to mothers.

Last month the Care Quality Commission (CQC) issued a formal warning to a hospital outside Greater London following three visits in February 2012. They found an increased risk of patient safety being compromised due to staffing levels and failure to complete risk assessment forms. It is not sufficient for maternity teams to just address existing unsafe care, they need to look at risks proactively, and ensure that a rigorous and robust risk management system is in place.

This is an ongoing challenge facing maternity services. Staff efforts to implement safety improvement programmes while ensuring continuity of care are hampered by a myriad of factors such as inadequate staffing levels, high and rising birth rates, financial constraints, and service reconfiguration. Some units are under-resourced and others consistently exceed their bed capacity. These challenges will continue for the foreseeable future. But what more can be done to ensure safety is not compromised and mothers and babies receive the standard of care they deserve?

Working with national partners, including the Royal College of Midwives, the Royal College of Obstetricians and Gynaecologists, and the NHS Litigation Authority, in 2009 The King’s Fund introduced an 18 month service improvement programme to support 12 maternity teams to deliver safer care to mothers and babies. This followed the report of an independent inquiry into the safety of maternity services in England commissioned by The King’s Fund which made practical recommendations for change.

Through our work with maternity teams, we witnessed firsthand some of the frustrations and challenges maternity teams face. We also witnessed genuine commitment to improvement and positive steps towards improving safety. We heard from chief executives walking the floor to hear about some of the challenges on their labour ward, to a maternity support worker taking the lead on introducing a change in practice to help identify incidents of postpartum haemorrhage. The teams’ local projects included improving safety through better staff training, communication, teamwork, implementing guidance/policies, and process mapping clinical areas, such as the triage unit. It was a real team effort and to coin a phrase from one of the project leads, it felt for the first time that they were “looking the same way,” despite staff facing an uphill struggle to achieve consistently high-quality, safe care.

The scale and pace of change in any busy clinical area needs to be carefully weighed against realistic expectations. In some cases there will be “quick win” steps that can be taken to improve safety, but in others, such as changing the safety culture or a wider system re-design, the change process is likely to be more protracted. To help facilitate a more seamless process, and to prevent other maternity teams from having to “re-invent the wheel,” we have captured the key learning from our 12 maternity units and presented it in a toolkit for maternity teams. The toolkit provides practical ways in which staff can address and improve safety within maternity services, sharing “hints and tips” about what the Safer Births maternity teams found particularly useful, and what hampered their progress.

The commitment and determination of staff to improve maternity care is evident, so too are the real challenges and frustrations they face on a daily basis. Support is needed to translate their efforts into delivering the results that the mothers in their care deserve. We believe the toolkit will help staff take that step closer to achieving and maintaining the level of safe care they strive to deliver.

Find out more about our improving safety in maternity services toolkit.

See our “Safer Births” programme work.

Vinice Thomas is the programme manager, Integrated Care Programme.

This blog also appears on the King’s Fund website at