1. BREAKOUT 1: Identifying the Gap (or Journey) (13.45 – 15.00)

2. WORKSHOP OBJECTIVES Present learning from pioneer sites and other teams, including their gap from current state to achieving their aim. Identify and explore the gap between now and where you want to be. Have fun!

3. SOME IMPORTANT NOTES Our discussions today are about learning, not about performance, so… sharing your challenges and failures can be just as important as sharing your wins and successes.

4. MEETING NORMS REFRESH Suspend judgment as best you can. Respect one another. Seek to understand rather than persuade. Invite and honour diverse opinions. Speak what has personal heart and meaning. Go for honesty without going on and on and on.

5. Site Sharing: Reflecting on Our Work to Date “There is a clear correlation between poorer pregnancy outcomes... in women who book later for antenatal care, attended infrequently or never attend for care. At present in Scotland, women and babies who are at the greatest risk of poor health outcomes are the least likely to access and/or benefit from the antenatal health care that they need.” (A Refreshed Framework for Maternity services 2011). Ensure that women experience positive pregnancies which result in the birth of more healthy babies as evidenced by a reduction of 15% in the rates of: stillbirths (from 4.9 per 1000 births in 2010 to 4.3 per 1000 births in 2015) infant mortality (from 3.7 per 1000 live births in 2010 to 3.1 per 1000 live births in 2015)

6. PROJECT AIM Promote enhanced interactions between parents and their unborn baby, resulting in improved attachment as well as strengthening engagement with maternity services. Resulting in a decrease in Do Not Attend rates at antenatal appointments in the Wishaw locality by March 2015.

7. DRIVER DIAGRAM Decrease in Do Not Attend rates at antenatal appointments in the Wishaw locality by March 2015. Primary drivers Secondary drivers Awareness of impact of lifestyle on unborn baby resulting in positive choices/changes Willingness to attend Engagement with Maternity Services Understanding value of services provided Available information Cultural Norms Ability to attend (organisational skills) Specific Change Ideas Focused Improvement Concepts Ideas: 1)Ante natal text prompt reminder with date and time. 2)Provide information on what to expect at appointment. 3)Promoting positive messages during pregnancy. Increase Uptake with texting service Guidance Engagement Relationship with staff and service Promote enhanced interactions between parents and their unborn baby, resulting in improved attachment as well as strengthening engagement with maternity services. Aim

8. Impact of the intervention I am continuing to grow and can hear and respond to sounds, light and touch. Share your pregnancy journey with other Parents-to-be by attending the local Parent education sessions. Find out more about labour, birth and getting ready for me. Call 01698354966 to book a place. 24 weeks Examples of Texts sent weekly Mum keep us both healthy - you have an appointment with your midwife around now. I can tell when you’re feeling relaxed, anxious or excited and can also feel these emotions too. I now weigh as much as a pineapple. 01698354966 Between 34-36 weeks

9. Data

10. Feedback from mothers Like the baby development messages. The text messages would encourage me to talk to my baby. Liked all the messages I have received, I would recommend the service. I especially liked the baby development messages. I would recommend the texting service. I really like receiving the messages as I have a 1 year child, so don't always have time to read or refer to my book

11. Learning for improvement Challenges around E-Health / IT – 11 page information governance form to send a text message! Uptake of text message service is high – seen as a normal way to engage with a service provider by mothers to be. Impact on clinic time by discussing sign up. Scaling up could be challenging.

12. Table Reflection and Discussion part one Using the guidance form – self assess your own work – 20 minutes Then turn to a partner and debrief your reflections – 20 minutes – questions next slide

13. Table Reflection and Discussion 1.Is your project(s) tied to achieving the big aim of the key change area or workstream? 2.Can you answer the 3 questions: aim, measures, change ideas? 3.Are you doing at least one small test of change per week? 4.Are you measuring data over time on one or more measures? 5.What will it take to move your project forward from where you are today to your aim for the CPP? 6.What assets can you draw upon from your partners and the community to move this work forward?

14. Discussing as a table, participants are invited to share what they realise they are missing and what they saw about their gap. Table Reflection and Discussion part two – 20 minutes

15. What did you discover in your review of where you are now? What surprised you in your discussions? What ideas are you taking home from your table discussions? For all of us as leaders are their leadership issues to consider? – Or leadership issues we need to escalate? REPORT OUT

16. PLEASE INSERT HERE (DURING SESSION): – Top 5 emerging themes based upon facilitator themes from tables. THEMES FROM THE ROOM

17. Parting Thoughts Today was about exploring and exposing the gaps, we close tomorrow! Take your explorations to CPP planning, share and discuss with colleagues today and reflect overnight Come back tomorrow for closure!

18. Thanks for a great session!