Be the Change

Whenever possible we ask members of the ASPH team to reflect on their improvement projects and share their stories.  Hopefully this helps to both share best practice and tips on the sometimes complex journey to making improvements in quality and safety; but also to inspire others in their own QI efforts.

This month we are pleased to share a blog by Jo Wilding-Hillcoat, Infant Feeding Lead Midwife in the Maternity Team at ASPH.  In this short blog, Jo shares the story of Project Joey, an improvement project led by the Maternity team that aimed to improve protected skin-to-skin time for new mums and babies.

This was a great multi-disciplinary project which made some significant improvements in both patient experience and the health and well-being of mums and babies.  You can see a summary of the project here.

We hope you find it useful and please leave your feedback in the comments section below.

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Project Joey started out as an idea for improvement that emerged as I, as infant feeding team lead midwife, had noticed a disparity in the birthing experience for women delivering in our Birthing Centre and women delivering on Labour Ward or having C-sections.

Skin-to-Skin Time

The benefits of early ‘skin-to-skin’ contact between mum and baby, as close to delivery as possible are well documented.  Uninterrupted skin to skin between mum and baby straight after birth has a number of health and well-being benefits for both, including thermoregulation of baby, creating an environment that encourages baby to feed, early colonisation of baby’s skin with mum’s flora and increased release of oxytocin and beta-endorphins.

As a team, we felt that some of our mums were missing out on this experience due to having a more ‘medically managed’ birth.

I discussed the idea with one of Be the Change team and soon we had a meeting arranged and managed to get a multi-disciplinary team together in one room. The initial meetings were really positive with everyone very keen to get the project started.

Testing changes

We started looking at what physical changes needed to be made for patients having elective C-sections.  Although there was ‘buy-in’ to the ideas from the theatre team, when we started chatting about what could changes could be made, we did come up against some resistance, not because people didn’t want to make changes but they couldn’t see how they could be made without causing delays or impacting on the medical care.

It felt like a bit of a stalemate – and then I realised what we needed to do – recreate an elective C-section and try out proposed changes!

We were lucky to have a Consultant Anaesthetist on duty that today that was very passionate about the project and rounded up a number of theatre staff to play various roles- including the soon-to-be mum.

It was an intense couple of hours and we worked through various scenarios, with lots of “tooing and fro-ing” and “that won’t work but this will” before a number of small but subtle changes were agreed that would allow mums and babies to have their special, important time straight after delivery.

The changes agreed were spread over time by the theatre team and the impact was quickly apparent with an increase in mums having skin-to-skin seen very soon after the changes were made and the increase has been sustained.

At the same time as these changes were being tried out, the multi-disciplinary team were meeting regularly to look at how the project could be promoted and it was decided that a poster was needed as a visual aid.

There were great ideas from everyone in the group and a poster was put together that showed the importance of skin-to-skin and how each area (antenatal, post-natal ward, theatres, etc) would help facilitate this.

There was lots of discussion on the content of the poster and the design process took one intense session with dozens of follow-up emails with differing and passionate opinions on how people “felt” about the poster.

This was another defining moment – the project wasn’t just my project, the design of a poster signified the start of people not just wanting to be involved in the project but being part of it and making it theirs.

Project Joey started to spread, mums-to-be started talking about it during their antenatal conversations, representatives from local NCT groups came along to the launch and took away copies of the posters to display at their meetings.  Staff wore badges encouraging mums and their families to ask about the project and the importance of skin-to-skin time.

Going For Gold

Nearly 18 months after the initial meetings, I led the maternity department through a very successful re-accreditation assessment of the UNICEF UK Baby Friend initiative (BFI level 3).

Although, Project Joey was a small part of the work required to maintain our accreditation, it was mentioned (with particular note) by the assessors as they felt it had impacted on the increased breastfeeding rate at discharge to the community as well as increasing the awareness of the importance of uninterrupted skin-to-skin time.

We are now aiming for the next level of accreditation – Going for Gold; the experiences of bringing the Project Joey together has helped to bring the key people together for the BFI and keep the momentum going.

As the aims of Project Joey now become business as usual I can look back on the work that has been completed with pride and admiration.  Without the hard work of the staff from all disciplines neither the stage 3 re-accreditation nor Project Joey would have come to fruition. I am proud to be part of Ashford and St Peters and how it embraces change.

Thanks,

Jo Wilding-Hillcoat

Infant Feeding Lead Midwife