Northern Ireland Adopting a Collaborative Approach to Improve Care for Women and Their Babies in Northern Ireland

Levette Lamb, Denise Boulter, Ann Hamilton, and Gavin G. Lavery

CONTENTS

Background..........................................................................................................214

Details of the Identified Success Story and Its Impact...................................215

Promoting Normalization of Pregnancy and Childbirth.........................216

Effective Communication (Inter-Professional and with

Women/Families)...........................................................................................217

Safe Labor and Delivery................................................................................218

Implementation: Transferability of the Exemplar..........................................219

Prospects for Further Success and Next Steps................................................219

Conclusion............................................................................................................220

Background

The health system in Northern Ireland (NI) has been integrated with social care for several decades and delivers services to a population of 1.8 million people via five integrated Health and Social Care (HSC) Trusts and the NI Ambulance Trust. The system, like many others, has used regulation and performance-managed targets as a means to improve standards of care. While this has undoubtedly produced successes, it has also led to behaviors that address targets without leading to improvement. The development of a system-wide body, focused entirely on quality improvement (QI) has helped increase recognition of (1) the contribution that QI can make to improving the processes of care, and (2) the importance of workplace culture to the delivery of high-quality care and the engagement of our workforce. In a time of resource limitation, QI is increasingly seen as the way to improve services for patients by harnessing the training, instincts, and expertise of staff.

Despite these advances, a big challenge remains. How do we move together toward this new way of thinking and working, and away from a system based on inspection and regulation, a system that seems to find itself attributing blame to staff who are increasingly stressed, demotivated, or disengaged?

Improvement across Health and Social Care (HSC) in NI over the next 5 years will continue to follow the 10-year strategic plan formulated in Quality 2020 (Q2020) (Department of Health, Social Services, and Public Safety [Northern Ireland], 2011). Themes in Q2020 include

  • • Transforming the culture
  • • Strengthening the workforce
  • • Measuring the improvement

The HSC Safety Forum (Safety Forum), established in 2007 and now part of the Public Health Agency, provides system-wide leadership in QI and safety, and facilitates the themes mentioned above. This has involved establishing QI collaboratives focused on specific areas of care (maternity, pediatrics, mental health, nursing homes) or specific problems (deteriorating patients, sepsis, acute delirium). In addition, the Safety Forum has grown QI capacity and capability by funding, facilitating, and providing training to both frontline staff and strategic leaders. Some of these trained individuals have led or supported the development of QI training at hospital systems level. This has consequently seen the development of ward-based teams using their QI skills to change how they work and measuring the improvement. This approach has led to an agreed set of attributes, an Attributes Framework (AF) for leading QI across the entire HSC system (Department of Health,

Social Services, and Public Safety [Northern Ireland], 2014). This AF is guiding both undergraduate and postgraduate staff training and development.

The demographic/societal changes common across the developed world mean the demand for management of long-term conditions (e.g., chronic obstructive pulmonary disease, diabetes, obesity, and alcohol-related conditions) is increasing rapidly. Technologically, HSC is relatively well placed, having developed and implemented a generic electronic care record (NIECR) that has widespread clinical engagement. While financial resources are under more strain than ever, paradoxically this has given QI some leverage, since spending our way out of the problem is no longer an option. We must redesign processes to be more reliable and less wasteful.

Other strategic drivers include the need to deliver increasingly complex (often hospital-based) care safely and reliably, and a growing consensus that hospitals will no longer be the hub for the care of long-term conditions. How do we design a system that appropriately balances high quality, safety, and sustainability with the wishes of citizens to have their care close to home?

 
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