While the report of the inquiry into the Mid Staffordshire NHS Foundation Trust (Francis, 2013) largely focused on the failings in the nursing and medical professions, it was also a reminder to the maternity service to review its systems and the quality of its care in line with the Code (Nursing and Midwifery Council (NMC), 2015). This article will outline an initiative set up by two labour ward matrons at Kettering General Hospital NHS Foundation Trust, entitled ‘Back to Basics’. Sue Davidson and Kathy Patrick reviewed clinical practices in their maternity unit and put in place an initiative to raise standards of care and ensure best practice was recognised, maintained and disseminated.
Why ‘back to basics’?
As labour ward matrons working predominantly in the clinical area, and having read the recommendations of the Francis report (2013) (Box 1), Sue and Kathy felt that a review of clinical practice in their maternity unit was required. They witnessed areas of care that were falling below the standards expected and so developed an initiative which would not only raise but maintain high standards of care. They produced an initial presentation outlining their intentions and presented this to Trust managers, line managers and labour ward coordinators, receiving positive feedback.
| Negative culture |
| Professional disengagement |
| Patients not heard |
| Poor governance |
| Lack of focus on standards of service |
| Inadequate risk assessment of staff reduction |
| Inadequate nursing standards and performance |
| Wrong priorities |
The vision: Sue Davidson and Kathy Patrick
We developed Back to Basics according to the values of the Code (NMC, 2015); focusing on all aspects of clinical care, such as dignity and respect, communication and professionalism, to ensure that women, babies and their families are at the centre of the care we deliver. We made some very simple changes in practice with the hope of making a significant impact on the experiences of women and their families.
Our first initiative was to set up a noticeboard in a prominent place on labour ward, highlighting how the Code (NMC, 2015) is translated into practice. We then set about addressing issues in the quality of care, firstly by focusing on improving care in relation to women's dignity and respect. We attached notices to all labour room doors asking people to knock and wait for an answer prior to entering a room, ensuring the woman was in a dignified state. This proved so successful that it was adopted by other departments, such as theatres and the outpatient department. The colour of these notices is changed every 6 months to ensure that they remain prominent.
‘With continued training and education we hope to maintain high standards and give the women we care for a positive and rewarding experience’
Cleanliness was monitored to identify potential issues. We decided to do this anonymously by collecting evidence in the form of photographs, to be included in our Back to Basics presentation. Staff responded well to this and were shocked to discover some of the things that were happening in their unit. Photographs included dirty rooms (some shocking), overflowing bins, bodily fluids on floors and dirty equipment. It was felt that some members of staff had become desensitised to their environment and needed to be reminded that women and their families are not accustomed to some of the sights we observe on a daily basis. As a result, bins are now emptied on a regular basis, women are not left in soiled sheets at any stage of their care, and equipment is cleaned and disposed of as soon as possible after birth.
In terms of communication, we placed posters in all rooms on the labour ward giving up-to-date information to women and their birthing partners on subjects including car parking, refreshments facilities, visiting times etc. We also encouraged all staff, whatever their role, to adopt a friendly and approachable manner to women and their families and to report to their managers if they witnessed any inappropriate behaviour.
Is it working?
It is important to ensure care continues to be of a high standard and so monitoring of practice is carried out on a continuous basis, with staff who consistently fall short of expected standards being managed through existing disciplinary procedures and appraisals. Uniform audits are also carried out on a weekly basis to ensure all staff are compliant and presentable. It is important that we don't rest on our laurels, so practice is audited to enable us to tabulate the results to indicate where further improvements are required. In terms of service user input, women are encouraged to complete a friends-and-family questionnaire (NHS England, 2015) indicating whether they have had a positive experience and would recommend our services to friends and family, or indeed whether they themselves would use our services again.
With continued training and education we hope to maintain high standards and give the women we care for a positive and rewarding experience. We present Back to Basics at our monthly maternity mandatory training days, ensuring all staff are aware of our aims and how we achieve compliance with the Code (NMC, 2015). Information is also passed onto staff via the Trust newsletter and any new or revised information is escalated to staff at handover on a daily basis, thereby improving communication.
Educating student midwives
In relation to pre-registration midwifery education, Sue and Kathy rely on mentors to teach and encourage high standards of care; however, it was felt that this could be supported by providing student midwives with a more formal introduction to the ethos of Back to Basics, so the initiative was recently introduced to the first-year student midwives at the University of Northampton.
The aim of this session was to instil appropriate practices as early as possible in the students' programme of study and empower them to challenge substandard practice supported by colleagues and managers in the clinical area. Students are the future of maternity services, therefore it is important for them to ensure all women receive the highest possible standards of care and that they have the courage to escalate their concerns when substandard care is seen. The session was very highly evaluated by the students (Box 2) and this collaboration between the university and clinical practice will continue with future cohorts.
| ‘This is a very positive approach to basic care, reiterating why I want to be a midwife’ |
| ‘Really good concept and great for students’ |
| ‘Really informative and eye-opening to see what occurs in practice’ |
| ‘Useful lecture to enable us to be the best midwives we can be’ |
| ‘Great inspirational and motivational talk’ |
| ‘The session really highlighted how the small things make a big difference in patient care’ |
| ‘A great initiative and an excellent reminder of the principles of good basic care’ |
| ‘Some really good ideas, strategies and initiatives taking place—other hospitals could use these plans to make a difference in care of women’ |
| ‘Very interesting, an eye-opener on how basic care is missed and how important it really is’ |
| ‘I really enjoyed the session, the photos were shocking but effective in hitting home about how important the basics of care are’ |
| ‘Really good to remind you to think about the basic care you give and how women and families feel’ |
The future of Back to Basics
Sue and Kathy are in the process of creating an award for staff who consistently perform to high standards and are an example to others. The award will be presented at a formal event and be included in the hospital magazine, demonstrating the importance of providing women and their families with the high standards of care they deserve, and encouraging all staff to engage with the initiative.
‘Back to Basics is not rocket science; it is a simple initiative providing reminders of what ‘with woman’ really means and how care should be delivered’
Back to Basics is not rocket science; it is a simple initiative providing reminders of what ‘with woman’ really means and how care should be delivered. While the initiative was created from the passion of two matrons in one maternity unit, it is anticipated that by sharing the philosophy with student midwives in the university setting, the simple message of Back to Basics will be disseminated to a wider audience.