This week’s Blog is written by Lana Jones-Sandy (@ljsan1) maternity risk manager at North Middlesex University hospital and @FNightingaleF Scholar in 2021. In the blog Lana reflects on a day in the life of a maternity clinical risk manager. In February 2022 Lana starts a two day a week secondment opportunity with NHS E/NHSI – as a Midwifery Clinical Advisor (HSIB).

What is your job title and your main role /responsibilities?

I am the maternity risk manager at North Middlesex University hospital. This involves working closely with the clinical leads and all levels of staff in the maternity service to ensure that lessons learned from incidents, risk assessments, risk investigations and complaints are disseminated to the wider team in maternity, across the division as well as working closely with external organisations. The role also includes encouraging a culture of openness and transparency that responds in a timely manner to potential or actual events that could perhaps have been managed better. In addition, I am responsible for ensuring recommendations from daily reviews and serious incidents are integrated into quality improvement strategies and plans.

How did you get into your current role/line of work?

My background is nursing and midwifery, I gained experience within the clinical governance team as a specialist midwife for audit, guidelines and risk management. This involved reviewing, writing maternity policies, guidelines, standard operating procedures, manage and lead on local and national audits, working with National Institute for Clinical Excellence toolkits. This gave me great insight of the importance of being responsive to recommendations from national clinical audit programme, ensuring the compliance and objectives are being met according to the local and national objectives. My drive and passion for patient safety inspired me to apply for the specialist risk midwife post and progressed to my current role as the maternity clinical risk manager.

What is your typical day like?

My day varies, from day to day, it, includes starting with a team huddle to assess the workload and plan for the day with the maternity risk team (specialist midwives and business administrator). The datix system is checked and discussed with the divisional governance team, identifying and cross checking the level of harm, incidents that needs urgent review and actions in the clinical areas. I also assist, if needed, midwives and other clinicians involved in serious clinical incident investigations. Other activities include:

• Attending handovers, safety huddles and other meetings
• Visible leadership
• Teaching – updates on maternity skills; Practical Obstetrics Multi professional training (PROMPT); doctors’ orientation

What advice would you give to others who would like to work in similar role?

This role is dynamic and requires flexibility!  it is important to have the relevant clinical experience, skills and knowledge in the speciality. Specific training such as claims and litigation, root cause analysis and human factors are quite useful in this role. A good understanding of external bodies such as NHS Resolution, Clinical commissioning groups, Healthcare Safety Investigation Branch, Local and National networks.

Good organisational skills, effective communication in writing and presenting with the ability to work under pressure and meet deadlines are some useful attributes. Key to this role is the ability to lead with compassion, good interpersonal skills and the ability to motivate and influence others. It is important to be approachable and visible to support staff as needed on a daily basis promoting best practice and ensuring safety is maintained. Appropriately supporting staff and families remains paramount in this role.

Supporting families and staff affected by patient safety incidents

Engaging with staff and families is very important in promoting safety. My Trust currently have a serious incident after care service available for staff following serious incidents. In addition to this service hot debriefs, round tables, one to one support and the professional midwifery advocates are also available. It is important for staff and families affected to have the space and opportunity to discuss the events. They deserve to know what happened when the outcome is not what they expected. It is understandable that some families, who have experienced a poor outcome, may feel angry and search for answers as to why this happened. Hence, multidisciplinary meetings, births reflections sessions and an open-door policy is also provided. During serious investigations, the key lines of enquiry also includes questions from the families. This same process is followed for the perinatal mortality review panels.

Listening to families is a priority to ensure learning from missed opportunities or poor outcomes are identified and managed appropriately.

Learning from events

Learning from incidents and reviews, requires honesty and transparency. Several ways have been tried and evaluated to share learning, such as maternity risk roadshows, mobile clinical governance board in the clinical areas, screensavers with weekly messages, learning summaries, trend analysis reports and key points reminders booklets. Quality improvements projects on improving incident reporting and medicine management were also useful.

During the pandemic, we took the opportunity to move the learning events virtually across the Trust. Weekly risk meetings are also held virtually which now gives more staff the opportunity to participate.

Key to effective risk management in the clinical areas are team work, multidisciplinary engagement and external input in reviewing serious investigations.

Effective communication with various organisation and ensuring a just culture, with transparency, open and honest conversations with staff and families to learn from events is vital. Highlighting areas of good practices and giving recognition for their hard work and dedication is done through, face to face feedback, greatix certificates and positive case summaries.

I am passionate and committed to a no blame culture, fostering learning for staff, and ensuring that a safety culture is maintained for staff and families