MIDWIVES MATTER - Developing a positive staff culture using Restorative Clinical Supervision

Quality Improvement Poster Download



Background & Problems

The PMA team based the QI project around the Delivery Suite as the Maternity Staff Culture and Engagement survey 2016 had demonstrated significant numbers of midwives were suffering from work related stress due to the emotional impact of the clinical work. The Delivery Suite area has been identified locally and nationally as an environment associated with dysfunctions in team relations and themes of undermining behaviour and reduced support for staff who need it the most.

The Safety Concern:

The patient experience is only as good as the staff experience which directly impacts on safety ( DH 2015) Delivery Suite is a high stress environment and staff are frequently exposed to serious incidents and emotional trauma.

Aim

The aim of the QI project was to engage 20% of delivery suite midwives in Restorative Clinical Supervision (RCS) from 01/06/2018 - 14/09/2018 to provide support to staff working in a stressful environment.

Method

The primary driver was based around facilitating the staff to engage with RCS. Meetings were set up with PMA leads and senior midwives and Matrons to discuss the relationship between staff engagement and a quality service and introduce the newly formed PMA team as a key player to influence a cultural shift towards an organisation which values a supported and engaged workforce.

The PMA recognised that in order to get engagement there were 4 main PDSA cycle themes :

1. Educate the staff abut A- equip and benefits of RCS
2. Introduce the PMA role to key strategic groups and gain support of senior staff
3. Facilitate staff clinical release to book RCS sessions in safe spaces
4. Deliver and evaluate effective RCS sessions

PMA contact has been mandated within the Trust and will be a contractual obligation for all new employees. The NHS England e learning module has been added to the Trust training matrix for midwives to educate staff of the model and its benefits for staff and women in our care. A publicity campaign followed the appointment of PMA staff in April, launching the model and PMA service in all areas of our county wide service. Communication systems have been introduced through intranet, generic e mail and generic mobile phone, and the team are considering use of social media to enable more direct contact and interaction with staff.

Results

• Successfully engaged with 20% of midwifery workforce on Delivery Suite in defined period
• Main contacts were through group attendance by adding to an existing meeting
• Positive staff evaluation of RCS following serious incidents
• On target to engage with 60% of workforce in 1st year across the county
• Good uptake of the A-equip e learning module

Implications

• Staff engagement with the PMA for 1:1 RCS has been challenging. Awareness of the role and service has been raised through education , communication, networking and visibility in all clinical areas. There have been significant issues with staff release on clinical shifts and the inflexibility 12 hour shift patterns create. The idea of introducing a pilot of a whole week of short shifts on delivery suite with a 2 hour overlap was introduced to the Division Matrons and approved. PMA’s will be available for the overlap period to offer 1:1 RCS and group forums. Staff will also be released for IPR, e learning and team meetings.
• Themes from RCS sessions have been collated and Feed Forward Forum s developed to discuss issues and form a self directed solution based forum
• Longer term evaluation of the PMA service on staff culture, sickness, recruitment and retention will be conducted
• Share examples of quality improvement with our Nursing colleagues in the Trust – January 2019 we present the PMA role and A-equip model at SNMC and discuss the upcoming PNA training – Professional Nurse Advocates !