Improving Women's Experience of Maternity Outpatient Clinics Brenda Kelly Lead Midwife Southern Health & Social Services Trust NIPEC Annual Conference Professional Standards Enhancing Person-Centred Care

Improving the Women’s Experience Maternity Outpatient Clinic The aim was to improve women’s experience of attending Antenatal Outpatient Clinic, Daisy Hill Hospital & Diabetic, Multidisciplinary Team, Antenatal Clinic, Craigavon Area Hospital The catalyst for this project was a review of the trends noted in both complaints and patient satisfaction questionnaires in both sites. Women highlighted Long waiting times Environmental issues including heating and signage No Clock! Particular concerns raised in relation to processes in MDT Diabetic Clinic in CAH where women are required to be reviewed by a number of professionals at a single appointment Improvement team established on both sites with facilitation provided by the Continuous Improvement Team

Introducing Our Quality Improvement Teams Daisy Hill Team Craigavon Team Aim was to build CI capacity and capability and confidence within the teams and identify champions to lead on this project with Lead Midwife and SMT support. Overall aim being to improve the overall patient experience and provide staff with the tools to identify opportunities to initiate and sustain change

Building Quality Improvement Capacity & Capability Lean E-Learning Process Flow Analysis Standard Operating Problem Solving Continuous Improvement E-learning opportunity identified Free access for all staff Accessible from work or home Initially staff were not convinced of the relevance and benefits of this approach however retrospectively some of the team members found this very beneficial and proactively shared these with their colleagues

Midwifery and Support Staff Roles and Responsibilities Exercise Explore and validate current team roles and responsibilities Identify opportunities for improvement Communication and time bound action plan Project Management Structure including Professional Lead and Service Improvement Facilitator Review of perceived v actual roles and responsibilities of staff in ANC which were subsequently validated by staff in attendance The following staff groups were involved in the activity – ANC Sister, Midwifery team, Administrative and Clerical, Maternity Support Worker, Health Care Assistant validated by staff in attendance WIN FOR STAFF = Increased understanding of roles and responsibilities, improved staff morale

Quality Improvement Tools Starting point was to understand current systems and processes Use of process mapping to review current antenatal booking and review processes allowed the team to Review current antenatal clinic patient pathway Identify non-value adding activities e.g. duplication of records across the team, leaving the department to collect labels, Identify service improvement opportunities e.g. appropriately placed and accessible equipment Maximise available resources e.g. streamlining midwifery workload Examples include Staff start times staggered to improve clinic start times and ensure that rooms are prepared in anticipation of mothers arriving Increased satisfaction and confidence from mothers Provision of a safe and responsive service

Empowering teams to make positive changes Proactive Engagement With Multidisciplinary Team to Drive Service Improvement Daisy Hill Team Craigavon Team FRUSTRATIONS AND IDEAS   Staff participated in a Frustration and Ideas Board exercise whereby over a 2 week period they were invited to post any issues regarding the department as well as ideas for improvements This tool allowed staff to openly display their frustrations and ideas about the department which led to an increased understanding of each others roles and responsibilities, generated a lot of discussion within and between disciplines and positively improved communication within the department This in turn made staff feel empowered to make positive changes Empowering teams to make positive changes

Proactive Engagement With Women to Drive Service Improvement

Proactive Engagement With Women to Drive Service Improvement

Feedback From Women attending Diabetic Antenatal Clinic

Review and Reorganisation As the primary focus of our practice we listened to what mothers and staff asked for Waiting times reduced Staff roles clarified Sequencing of activities and roles at diabetic clinic Electronic check in system installed to ensure mothers taken in order

Low Cost, No Cost Changes Station for staff to store Diabetic Clinic Information A Whiteboard and clock to assist with timings and job allocation A notes trolley was secured which keeps patients charts tidy and ordered Room Numbering and Signposting Dedicated Chart Review Area Midwifery time released reinvested into face to face contact with mothers Communication “whiteboard” erected to allow for prioritisation of key tasks and to support managing patient flow through antenatal clinic Workplace organisation - rooms re-organised to reduce time spent looking and searching for information and equipment and release time

Improvement in Professional Standards Women advised that antenatal clinic areas could be warm – fans placed in waiting areas with a view to installing air conditioning To reduce waiting times staff rostering was reviewed to match capacity to demand including available midwifery and obstetric resources Increased staff morale and confidence

Impact to Women’s Care and their experience Decrease in waiting times at clinics Improvement in ambience of clinics - better organised, signage improved, dedicated clinic areas to improve organisation and flow, fans installed to improve comfort for women Increased confidence in waiting order through installation of electronic check in system

Conclusion In conclusion both women and staff have benefited from the service improvements implemented at the antenatal outpatient clinics in the Southern Health and Social Care Trust Increased staff confidence to undertake further service improvement  

Recommendations: Satisfaction surveys to be repeated bi-annually Air conditioning to be installed in antenatal clinic waiting area subject to available funding Staff ideas and frustrations board exercises to be undertaken at team meetings or scheduled “Time out for Teams” Service demand should inform rostering of staff and clinic template

If you have any queries in relation to the Maternity Outpatients Improvement Projects Craigavon Hospital Joan Moffett, Joan.moffett@sotherntrust.hscni.net 028 3861 2359 Daisy Hill Hospital, Joanne.mcglade@southerntrust.hscni.net 028 3083 5000 Ext. 3310 Improvements at the clinic are ongoing and a work in progress!