WINNER'S CASE STUDY
Maternity Information System, Cumbria NHS Foundation Trust
Overall Project of the Year: 2019
Social Project of the Year: 2019
By digitising the records of expectant mothers, North Cumbria Integrated Care, an NHS Foundation Trust (North Cumbria) brought efficiency – and safety – to its maternity services.
Babies are born in hospitals across the UK every day, but very little thought is given to how life-and-death the process can be. Pregnancy and birth can be fraught with complications, and frontline staff need the right information to be able to act fast if something goes wrong.
NHS services are under increasing pressure as funds are stretched and demand increases. As a result, NHS Trusts are innovating to ensure that they can deliver the right level of healthcare. Recognising the critical need to ensure a consistent level of care across maternity services, the NHS rolled out a national programme to achieve the recommendations set out in the 2016 review Better Births. Electronic records were a key element of this – NHS Digital set a target of providing 100,000 women with electronic records by October 2019.
North Cumbria had maternity patients on a mix of paper and digital records. Staff were required to duplicate records, and data quality and staff efficiency were suffering as a result. The organisation conducted a risk assessment in August 2018 and unearthed a number of hazards, some of which had resulted in real incidents. Something needed to be done to improve the efficiency – and increase the safety – of the service.
The decision was made to transfer to all-digital records, in line with national NHS plans. The project board consisted of a digital midwife; the head of midwifery; an applications manager; a business manager for women’s and children’s health; obstetricians; a benefits and change manager; a project manager; and a project officer. The project would be managed according to the organisation’s PMO Handbook, working under the Association for Project Management (APM) and PRINCE2 principles.
It was crucial that the project delivered real results; that women actually used the digital services. This was important not only from an improvement perspective, but a funding perspective as well – £50,000 of funds would be provided by the Maternity Transformation Programme, but only if 20 per cent of patients were registered on the system within a month of going live.
Paul Carruthers was project manager on the project: “Due to the tight timescales imposed by the NHS Digital funding, the project was high pressure and keeping momentum going was only possible by coming together as a team to make decisions and hit project milestones,” he says. “While risks and issues were managed daily, getting updates at team meetings and fortnightly project boards was essential in having the knowledge to update or close risks and issues regularly.”
Delivering the right system
The project board selected the Clevermed BadgerNet ePHR Maternity system as the software that would form the foundation of the project. Alongside this, the Maternity Notes app would be used for patients to access their records on their phone. This would allow the organisation to have a single digital record, reducing paperwork for frontline staff. They were to provide 4G and WiFi-enabled devices to ward and clinic staff so that they always had access to records.
The team started working with Clevermed, with Carol McGovern managing the project from the supplier side. “I looked at the project at a scope level and said: ‘this will keep me busy for six months’. We'll crack some infrastructure and roll out some software, and jobs a good'un and we'll get this over the line. That's what I've done in other parts of the health service for years. Maternity is something very, very different and needed a real breakthrough of all the business processes and it's hand-in-hand engagement with maternity colleagues that reaps the biggest value.”
“One key part of this project was ensuring we were choosing the correct system and app that would allow us to give the women of today’s society what they needed from digital maternity notes,” adds Carruthers. “To understand their needs, the digital midwife arranged for herself and the project team to attend some local schools and colleges. This proved essential to the project as it allowed us to target 16-25-year-olds who are the current generation that will be accessing the maternity services in the coming years.”
Alongside the maternity project, the two NHS Trusts in North Cumbria – Cumbria Partnership Foundation Trust and North Cumbria University Hospitals Trust – were going through a merger. The North Cumbria PMO had already joined together, but it meant that the central team had to work across organisations to deliver the change.
“Between the two Trusts, processes and ways of working are still very different and quickly learning the processes, hierarchies and contacts within another organisation was key to the success of this project,” says Carruthers.
The upcoming merger had left staff morale low. There was some resistance from some staff to work with people from the other trust. “By engaging with these teams and individuals early on, listening to their concerns, demonstrating the actions that were put in place to ease their concerns and by gently reminding all involved of the real reason we are here doing what we are doing – the patients, the women, the babies – we were able to work together successfully,” says Carruthers.
That focus on protecting mothers and babies kept everyone on track. McGovern visited the maternity and neonatal wards at North Cumbria hospitals and says that the visits were at the front of her mind when working on the project. “If you've ever been in a neonatal unit and seen a tiny 28-week-old baby at two pounds, that's a sight you can't unsee. It's harrowing. But the day that I was in theatre and saw a 28-week baby delivered, I got to see that baby go through their entire visit and go home six months later. It was hugely gratifying.”
After the project went live, a session was held to capture the successes, failures and lessons learned. Information from other Trusts that had implemented the BadgerNet system had shown that engagement with the app had been low. The team worked hard to overcome this by changing the way that women accessed midwife services.
All women now refer themselves by navigating to the Trust’s website and selecting the midwifery team in their area. This takes them to an email form to complete and send through. The midwives set women up on the app prior to their first antenatal appointment. This has driven the engagement with the app – 100 per cent of women have agreed to access the app with 98 per cent utilisation rate.
Midwives were trained on how the app worked to help them understand what they were offering to the women and allowed them to support the women with their questions/queries. This involved a combination of an eLearning package and one-on-one training.
“This meant that during their training, they were already familiar with the system and it allowed for more time to go through the content and ask questions,” says Carruthers. “Other Trusts have also asked if our Training team can share the eLearning that has been created as it has proved extremely useful.”
“I've worked in the NHS for the last 20 years and had my little boy last year,” McGovern adds. “So I've seen it essentially from the customer and the supplier side of things and it completely changed my viewpoint. Getting to carry, my handheld record on my phone was so important rather than leaving the bit of paper at home and if something happened, had the notes there so that the clinicians could give me the care that I needed. It was fantastic.”