At the end of November 2024, members of the ‘Safer systems, cultures and practices’ team attended ‘The PRactical Obstetric Multi-Professional Training (PROMPT) Symposium’ in Bath, Somerset.
The two-day programme included a broad range of presentations. A variety of global leaders and arms-length bodies within maternity services demonstrated the complex landscape and intricate challenges of maternity safety.
The symposium was a fantastic opportunity to observe the interaction between systems, organisations and culture within maternity safety; building on our study exploring PROMPT an example of organising a system around known risks.
As part of our study focussing specifically on the obstetric emergency Post Partum Haemorrhage (PPH), we have so far conducted documentary analysis, interviewed key stakeholders such as regulators and policy makers, and held a workshop with the core PROMPT Foundation team. This study is contributing to our wider understanding of the practices, skills, resources, systems and activities that ultimately support safe healthcare.
What is the PROMPT Maternity Foundation?
The PROMPT Maternity Foundation is a UK-based charity, working to reduce preventable harm to mothers and babies in maternity care.
Established at Southmead Hospital, Bristol in 2006, PROMPT is for midwives, obstetricians, anaesthetists, paramedics and allied maternity staff and aims to strengthen knowledge and teamwork during simulated obstetric emergencies. The team emphasised the importance of ‘training in the local system’ together with multiprofessionals, in addition to clinical knowledge and skills. Maternal and neonatal outcomes (e.g. reduction in neonatal hypoxic brain injuries or shoulder dystocia related injuries) were improved following local implementation.
The PROMPT team have since upscaled via a ‘Train the Trainer’ franchising method; allowing implementation across the UK, within undergraduate teaching and with partners across the globe. Teams from New Zealand, Australia, Abu Dhabi, Germany and Wales showcased their implementation of PROMPT around the world during the symposium.
Keynote Speakers
Inequities in maternity care: Black Maternity Matters – Presentation from Katie Donovan-Adekanmbi & Aisha Thomas (Black Maternity Matters Collaboration with Health Innovation West of England)
Racism within healthcare remains insidious and institutional. Within England’s maternity services, there are glaring and persistent disparities in outcomes for women depending on their ethnicity. Maternal mortality for Black women is currently almost four times higher than for White women and significant disparities also exist for women of Asian and mixed ethnicity.
Katie and Aisha highlighted examples of cognitive bias informing clinical decisions which can lead to detrimental and unacceptable health outcomes. Some of the examples included prejudiced assessment of pain threshold and clinical equipment such as oximeters calibrated for white skin only and therefore inaccurately estimating oxygen saturations in darker skin tones.
Their emotive presentation underscored the necessity for cross-cultural literacy including undergraduate training, academia, senior leadership and policy makers. It was a stark reminder that although health disparities are acknowledged (for example, Maternal, Newborn and Infant Clinical Outcome Review Programme, delivered by MBRACE-UK) – there is still a requirement for systematic change throughout the healthcare system to improve maternity care for all members of our society.
Improving improvement in maternity care: Professor Mary Dixon-Woods (Director of THIS Institute)
Mary’s programme of research focusses on generating high quality evidence-base to support improvements in the organisation, quality and safety of healthcare.
Presenting on maternity challenges specifically, Professor Dixon-Woods highlighted the concept of “priority thickets”; overlapping or disjointed goals that command substantial attention and resource, but do not necessarily provide clear direction or coherent visions linked to local priorities.
Maternity reports, inquiries and news headlines regularly highlight challenges, but seldom include actionable and sustainable solutions. They sometimes focus on individual training but do not tackle socio-technical change.
Furthermore, improvement capabilities vary across sectors, specialties and regions and this can deepen inequalities. Professor Dixon-Woods recommended “co-design at scale and do it inclusively” to improve quality and safety for the future.
Maternity Incentive Scheme NHS Resolution: Bridget Dack and Selina Dubison
NHS Resolution (NHS-R) is an arm’s length body of the Department of Health and Social Care, providing expertise on resolving concerns, disputes and litigation fairly. Bridget and Selina highlighted that a substantial proportion of NHS-R claims originate from maternity services (56.7%) and this represents a huge annual cost of £66m.
Their presentation acknowledged NHS Resolution’s role in claim management, but also focussed on their capability in supporting the NHS in aspects of safety and learning; helping Trusts understand their claims risk profiles to target their safety activity, while sharing learning across the system to improve patient care.
The Maternity Incentive Scheme (MIS) is a financial incentive program with 120 participating NHS Trusts. Trusts that can demonstrate they have implemented a set of core safety actions will receive financial renumeration. The programme also identifies Trusts that are non-compliant and therefore require support in enacting improvement plans.
There was insightful discussion from this presentation surrounding the combination of money and safety; whether this was “distasteful” incentivisation or perhaps a useful lever for promoting improvement in maternity services, particularly to Trust Executives.
Other notable speakers
There were also opportunities to simulate obstetric emergencies and attend captivating presentations from speakers; including Abbie Ward – (England Red Roses / Bristol Bears Women’s Rugby Player) who shared her pregnancy and post-partum experience as a high performance athlete. Panel discussion also included representation from Dame Lesley Regan (Professor of Obstetrics and Gynaecology), Birte Harlev-Lam OBE (Director of Royal College of Midwives) and Dr Fiona Donald (Consultant Anaesthetist).
Take home messages
The take home messages of the conference for me, included the overwhelming complexity of the maternity safety landscape (e.g. guidelines, recommendations, reports and regulators which all contribute to priority thickets).
Additionally, the persistent societal challenges that lead to health inequality and require urgent, remedial attention.
And finally, the importance of opportunities, such as this symposium, for maternity safety people, at all levels of the system to come together in the same (beautiful, Guild Hall) room and collaborate.
The wealth of expertise, compassion for patients and their families and desire to improve their services, was truly inspiring.
Eve Duke, Pharmacist at Leeds Teaching Hospitals and Development Awardee completing a placement with the ‘Safer Systems, Cultures and Practices’ theme within the Yorkshire and Humber Patient Safety Research Collaboration (YH PSRC).