1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. Proactive Engagement With Women to Drive Service Improvement

9. Proactive Engagement With Women to Drive Service Improvement

10. Feedback From Women attending Diabetic Antenatal Clinic

11. 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

12. 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

13. 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

14. 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

15. 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  

16. 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

17. If you have any queries in relation to the Maternity Outpatients Improvement Projects
Craigavon Hospital Joan Moffett,
Daisy Hill Hospital,
Ext. 3310
Improvements at the clinic are ongoing and a work in progress!