Below is one of the case studies written by contributors to the Each Baby Counts project.
The North West Coast Strategic Clinical Network – Supporting external representation on review panels
Dr James Boyes, Quality Improvement Programme Manager (Maternity & Perinatal Mental Health)
The North West Coast Strategic Clinical Network (SCN) has been supporting its trusts to secure external input to their Each Baby Counts Root Cause Analysis (RCA) review panels for several years.
When a review is called, the host trust contacts the SCN to let them know when & where the panel is being held, the broad nature of the incident (e.g. an intrapartum stillbirth) and the type of external input being sought (e.g. midwifery, obstetric and/or neonatology input). To support that process the SCN holds a database of clinicians from across the region who have expressed an interest in supporting these panels. The database is regularly refreshed to take account of movements in staff across the network footprint.
The SCN’s Special Interest Groups are used to gain commitment to the process with the Management & Reduction of Stillbirth Special Interest Group playing a key role. Once external clinicians have been identified, the SCN forwards their details onto the host trust who then coordinate their involvement in the panel itself. This approach ensures that trust governance processes are supported because no patient data is shared with the network. Once the review panel has concluded, the trust works with the SCN to produce an anonymised summary of the lessons learned from the incident. This template is also used for other relevant non EBC reviews. The completed templates are fed into the appropriate Special Interest Group for discussion before being fed into the region’s Maternity Clinical Experts Group for further dissemination.
The SCN also holds regular Study Days where these cases are analysed for common themes which form the basis of directed improvement work. Last year almost 30% of the region’s EBC panels had external representation. Improving this figure will involve further raising awareness of the process to up the numbers of requests for representation being made and increasing trust level commitment to the process (e.g. supporting clinicians to attend the reviews).
Our work to date has highlighted that barriers include raising awareness of the process for arranging representation, engagement with trusts to request representation, the time pressures set by external bodies for completion of the report, the time required for review, managing voluntary representation at reviews and managing conflicting priorities within the trusts.