The Ockenden (2022) report into maternity services at Shrewsbury and Telford NHS Trust identified ‘persistent failings’ and ‘missed opportunities’ at every level of patient care (Javid, 2022; Vize, 2022). The report also highlighted shortcomings in leadership, teamwork and culture.
To ensure that the authors’ patients and team benefited from the report's findings, ‘Ockenden cafés’ were established for staff and service user representatives at their hospital. The aim of the cafés was to raise awareness of the immediate and essential actions from the report, and how these impacted everyone, daily.
Staff were encouraged to drop-in and have an informal discussion on a topic relating to patient safety, with an emphasis on human factors and staff culture, over a cup of coffee. It was hoped that this would encourage staff to discuss and reflect on serious and often difficult to broach topics, with the ultimate aim of improving patient safety.
These informal discussions encouraged staff to speak openly and honestly about safety issues in a non-judgmental, non-hierarchical forum. The voices heard in the sessions were often staff who did not attend or speak in more formal meetings.
The cafés have helped to flatten hierarchy and strengthened working relationships in the entire multidisciplinary team. It has been valuable to hear the perspectives and opinions of the multidisciplinary team and have the involvement of service user representatives.
What is an Ockenden café?
The cafés are organised and attended by a multidisciplinary team that includes obstetricians, midwives, neonatologists, anaesthetists and service user representatives. Students, trainees, maternity support workers and receptionists are all also encouraged to take part. The cafés were established collaboratively with the Maternity Voices Partnership, who attend the café sessions to represent the service user voice. All café sessions are facilitated by at least two members of the multidisciplinary team organising group and are attended by a broad and inclusive range of the team, including doctors from different specialties and midwives, as well as administrative and managerial staff.
Each Ockenden café is based around one of the immediate and essential actions from the Ockenden report. Examples of actions discussed include: listening to women and their families, enhanced safety, risk assessment throughout pregnancy, staff training and working together, and complex antenatal care. Once a theme is identified, a real life scenario is discussed from the maternity unit. The cases discussed come from the risk and clinical governance teams, birth reflections, quality improvement projects and service user feedback themes.
The café sessions take place at different times and on different days, across a variety of relevant locations from the labour ward to the community midwifery base. This recognises each part of the service, and has meant that team members who may not otherwise attend such a session have felt included and been keen to join.
All café sessions have a similar structure. After introducing the session and the immediate and essential action being focused on, team members work in small groups and discuss the scenario. Each group thinks about learning and practice points that the scenario brings up and then shares with the main group. The café sessions are a safe and confidential space where all members of the multidisciplinary team are invited to feedback, irrespective of role or grade, which has been found to flatten traditional hierarchy.
Impact
A feedback survey was carried out following the first set of cafés, and 92% of respondents felt that the sessions had improved multidisciplinary team communication and staff were keen to continue the sessions on a monthly basis. Staff also suggested future topics and scenarios to discuss. Staff feedback is shown in Box 1.
Box 1.Staff feedback on the Ockenden cafes
- ‘The cafés improved team spirit, with an emphasis on culture.’
- ‘What is achievable when we work together.’
- ‘Very positive [multidisciplinary team] engagement.’
- ‘Great to work with our Maternity Voices Partnership.’
- ‘Great to be involved with a team who genuinely want to do better.’
- ‘It was great…really got people talking.’
- ‘People engaged and felt listened to.’
- ‘The sessions created positive momentum in the unit.’
The Maternity Voices Partnership co-chair recently commented that ‘as the groups talk through the case study you can hear they're listening to one another but bringing it back to the mother…and hopefully this is having an impact on the next mother they care for and the care is constantly improving’.
The cafés were hugely successful in the department and within 6 months of the first café, a bid was secured from the hospital charity to support a further 12 months of sessions.
When there have been actionable learning points from a café session, the senior team have been informed and improvements have been made in our unit. One example is the development of a new guideline for women who request care outside of guidance. During another café, it was acknowledged that there is an inequity in birth environments between the birth centre and labour ward. The ‘birth experience kit’ was developed from this and funded by the Whittington Health Charity to provide tools to enhance birth environment in all settings, reducing this disparity.
Next steps
More than a year after the first café took place, the Ockenden cafés have become a regular part of unit life. Staff from all areas enjoy attending and having the opportunity to pause and reflect with colleagues. The authors will conduct a further survey to review the needs of the multidisciplinary team and how to develop moving forwards. In the meantime, the most recent immediate and essential actions are used to inform the discussion topics and guide ongoing service improvements. The Ockenden cafés were recently shortlisted finalists for the Health Service Journal Patient Safety Awards.
Conclusions
Ockenden cafés are a multidisciplinary initiative, which has supported a positive culture change in the unit. This has been especially important given the current challenges facing all healthcare professionals working in maternity services. Following the success of the cafés, the authors are keen to encourage others to implement an initiative such as this in their unit to support culture change.