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Key lessons

The evaluation findings in the report demonstrate the programme’s success in achieving local change and impacting on maternity culture. What can everyone else learn from this?

The impact of local diagnostics

Maternity units across the country have more in common than they realise

Barriers to change were similar across all units. This included staff morale and change fatigue, time, and difficulty accessing certain staff groups. The campaign approach was therefore developed to tackle all the barriers and demonstrated success in all units regardless of their size and geographical location.

The impact of human factors and safety thinking

The interventions were developed with a sound background understanding of human factors, safety thinking, and human behaviours, using experts in the field to help guide the design process. Crucially, behaviours were linked with patient safety. This meant that when introducing methods of behavioural change, it was understood that simply telling people to act in a certain way is likely to fail, particularly with staff groups who are entrenched in longstanding cultural norms. Instead, introducing simple but specific structured conversational tools normalises certain behaviours, and empowers junior staff to speak up. This in turn has a positive impact on psychological safety and culture overall.

The impacts of campaigns

The interventions were introduced with carefully constructed, impactful campaigns. There were multiple reflections along the way, and the approach was consistently tweaked to produce the final interventions contained within this toolkit

Break large ambitions into small, manageable projects

Although the overall ambition was large; “to improve clinical escalation” in an intrapartum setting, this overarching theme was broken down into smaller, more manageable projects. This allowed the teams to gradually build on each success, which in turn gave both them and the programme credibility when introducing new change ideas.

The importance of the “bottom up” approach

One of the things that was consistently mentioned in both the analysis of the programme but also when discussing it at regional and national conferences, was the importance of the “bottom-up” approach. There is often a disconnect between national strategy and front-line staff, with a feeling that policy is created by people who rarely, if ever, do clinical work. The fact that all the interventions were co-produced and tested by multi-disciplinary staff working in a clinical setting, has led to a high level of acceptability. By introducing the interventions in a diverse range of units (teaching hospital, DGH, rural, inner-city), the programme also demonstrated that positive change is possible everywhere, and maternity units have significant commonalities, no matter where in the country they sit geographically and socio-economically.

Measure improvement and celebrate successes

The programme also had a focus on both measuring improvement and celebrating successes, which were in turn communicated to staff at all levels. Demonstrating tangible improvement and benefit had a positive impact on the units, particularly at a time when staff morale was at an all-time low due to the pandemic.