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University Hospitals of North Midlands NHS Trust

Below is one of the case studies written by contributors to the Each Baby Counts project.

Risk Management at University Hospitals of North Midlands NHS Trust

Simon Cunningham, Lead Reporter for Obstetric Risk at University Hospitals North Midlands, Masters Student on the Elizabeth Garrett Anderson Programme at the NHS Leadership Academy, and Each Baby Counts Lead Reporter for University Hospitals of North Midlands NHS Trust

A cornerstone of risk management is gaining engagement from investigating clinicians to define the lessons learned and to promote effective development. In my experience, most risk management teams are comprised of relatively senior staff however it is well documented that encouraging team diversity promotes engagement from individuals, fosters innovation and builds trust (Mickan and Rodger 2005; Macleod and Clarke 2009; West and Lyubovnikova 2013). Ultimately teams represent the building blocks of an organisation and will affect the application of knowledge, resources, service delivery and define the patient experience.

Taking part in Each Baby Counts led us to restructure our investigation of major incidents. Within systems of care it has been suggested that reduction of variation of outcomes can be achieved by the transition from individual practicing of medicine as a craft across the spectrum, to developed coherent teams with situational awareness (Britnell 2015, p.171). Bringing these threads together we decided to make all junior staff from ST3 onwards lead investigators of care where neonates received cooling as junior staff are usually first responders when intrapartum concerns are raised. We wanted to make the investigation an active platform for our leads to appreciate important factors within the continuity of care, effective team-working and to provide additional experience of key decision-making. We also felt that their diversity would provide us with key lessons for improvement and assist the dissemination of those changes.

We worked with the junior staff to define the process to them and to focus on why their involvement was critical. The risk team then facilitated their investigation and removed friction, for example, by establishing the components of a timeline. There is named consultant supervision on each investigation and all drafts are discussed via email or open meeting by the whole team. Whilst junior staff may not have the same volume of experience as senior team members, I believe the recent junior doctors’ strike demonstrated their greater familiarity with operational processes.

We are currently still in the early stages of establishing this change of practice and thinking, however in the longer term our hope is that it fosters insight, self-efficacy and a growth mindset for situations that will often be very difficult. It will also result in earlier exposure to service redesign and change management within junior doctors’ careers. They are tomorrow’s medical leaders and many studies demonstrate their ability to contribute to service development beyond clinical practice. Ultimately it has been found that engaged employees practice two jobs: the day job and improving the day job (Ham 2012).


Britnell, M. (2015). In search of the perfect health system. 1st edition. London: Palgrave.
Ham, C. (2012). Leadership and engagement for improvement in the NHS: Together we can. The King’s Fund. [online].

Macleod, D. and Clarke, N. (2009). Engaging for Success: enhancing performance through employee engagement. Department for Business Innovation & Skills, 1, pp.1 –124. [online]. 

Mickan, S.M. and Rodger, S.A. (2005). Effective Health Care Teams: A model of six characteristics developed from shared perceptions. Journal of Interprofessional Care, 19(4), pp.358–370. [online]. 

West, M.A. and Lyubovnikova, J. (2013). Illusions of team working in health care. Journal of Health Organization and Management, 27(1), pp.134–142. [online].

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