Father Christmas: Doctor, Doctor I feel so unfit
Doctor: You need to go to an elf farm
With Christmas upon us, it is all too easy for us (well, me at least) to forget that there are people who will not be stuffing themselves with turkey and sharing hilariously bad Christmas cracker jokes on Christmas Day. Instead, all over the country, hundreds of public service workers will be on duty as usual, putting out fires, breaking up fights, arresting criminals, saving people’s lives, and delivering babies.
The M(ums)power team recently ran two workshops with a range of clinicians from two major NHS trusts, UCLH and NUHT, bringing together GPs, obstetricians and community and hospital midwives in order to explore their thoughts about and experiences of delivering antenatal care, and their ideas about how the system might be improved. These workshops followed on from two sessions that we ran with pregnant or new Mums to learn about antenatal care from the service user’s perspective. What came across in our conversations with Mums was the extent to which most of them really valued their interactions with health professionals; notwithstanding a few exceptions where women spoke of ‘grumpy’ or ‘rude’ individuals, most of the ‘high points’ of their pregnancy occurred when they met with the midwife or had some form of contact with health services, with scans and appointments serving as key milestones along their journey. Admittedly, a smiley face and a reassuring manner can’t solve every problem (and you can read more about some of the issues and inefficiencies that our workshops with women uncovered here), but they do go a long way, and it was common to hear phrases such as ‘I had a really lovely midwife’ or ‘the doctor was really supportive.’ Much like the ‘favourite teacher’ that we all remember from school, it was these kinds of positive interpersonal relationships that the women felt had made all the difference to their experience, paying testament to the incredibly important and valued work that doctors and midwives do every day of the year.
It would perhaps be natural to assume, then, that working in antenatal care is a fulfilling job; indeed, it is something of a truism that ‘working in the caring professions isn’t well paid –but at least it’s rewarding.’ And yet our workshops with clinicians revealed a more complex reality, highlighting the frustrations that come along with trying to deliver high levels of care within a system that feels under resourced and overstretched.
What are your experiences?
We began our workshops by presenting clinicians with a map of the pregnancy journey that we developed based on the NICE guidelines, which visually represents the number and timings of appointments and scans that women will receive, as well as the various tests, assessments and information that they are given. We then asked the clinicians to reflect on this map and to note down some of the challenges involved in delivering good quality antenatal care according to their own experiences. Across the two hospitals, some common themes emerged, including:
• Administrative processes are inefficient and waste time
From the booking and referral system to the process for recording and sharing information about women, midwives in particular felt that these systems were inefficient and tended to take valuable time away from ensuring thorough, in-depth and informative conversations with women. Issues included time wasted through having to input information into different information management systems (often with a lot of overlap), as well as the difficulty of booking appointments at busy and oversubscribed clinics.
• Poor communication between GPs and other maternity services
Many women like to go to their GP as their first port of call, particularly if they have a pre-existing relationship with him or her, and yet it was acknowledged that the role of the GP in the antenatal journey is minimal. GPs are often ill-informed about antenatal care, and there is not sufficient link-up between GPs and other maternity services; for instance, GPs are not informed of the test and assessment results conducted during the patient’s’ pregnancy.
• Quality of interactions between women and clinicians is compromised due to lack of time
Appointment times are insufficient to provide women with the quantity and quality of information and reassurance that they need: this was a recurring message to come out of both workshops. Midwives were concerned that women were leaving appointments with outstanding anxieties and questions that they had not had time to properly address. Other factors affecting the quality of clinician-patient interactions included language barrier, lack of continuity of care (different midwives always seeing different women) and absence of notes in cases where women had forgotten to bring their notes.
• Women are not sufficiently well-informed
At certain key stages, the information given to women is weak. For instance, women are not given enough information or choice related to place of birth, and not enough is done to manage their expectations regarding their birth plan. Women must be supported to fully understand that they may not be able to follow their birth plan if complications arise during the labour.
• Lack of support and review mechanisms in place for clinicians
Some participants felt that it was important that there should be more support mechanisms in place for health professionals, not only to help them to develop and improve their practice but also to assist and support them to manage their stress levels. This might for example take the form of more workshops and training, or peer support groups.
What are your ideas for improvement?
‘More time, staff and resources’ was for many clinicians the obvious answer to the question of how we might make improvements in antenatal care – an understandable response given the enormous pressures that maternity staff are under in light of Britain’s recent baby boom and its chronic shortage of midwives. Interestingly though, when we asked them to ‘think big’, they thought big, and brought numerous creative and interesting ideas to the table, some of which are recorded below:
• Big Idea No. 1: Increase continuity of care
Have tag teams of midwives who are given a specific caseload of women that they should have responsibility for throughout their pregnancy in order to increase continuity of care and enhance communication
• Big Idea No. 2: Be more organised
Improve the organisation of both indivduals and systems by ensuring that there are clear protocols and templates in place for information-giving and coommunication between midwives, obstetricians and GPs
• Big Idea No. 3: Share the load with GPs
Have a system that enables information sharing between GPs, midwives and hospitals; empower GPs to play a more supportive role in women’s pregnancy through operating a ‘helpline’ whereby GPs can access information and advice from obstetricians if they are unsure about anything
• Big Idea No. 4: Increase support and professional development for clinicians
Develop peer support groups and platforms for clinicians in order to boost mutual support and learning; build in regular performance reviews and feedback and reflection sessions into clinicians’ professional development to ensure that they are constantly improving their practice
These were just a few of the excellent ideas that clinicians came up with to enhance the quality of maternity services and thereby improve levels of job satisfaction and the quality of women’s experiences.
In the new year, the M(ums)power team will bring together women with clinicians to begin to develop and refine these ideas further. We are excited about the high levels of energy and excitement that have been generated around this project over the past month, and even more excited about making some fo these great ideas into a reality in the new year. Roll on 2012 – and Merry Christmas every one!