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Nursing Times Awards 2010

Improving Maternity Services Award

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WINNER: Reducing caesarean section rates using organisational change - The Blackpool Way, Pauline Tschobotko, Moira Broadhead, June Davis and Nicola Parry, Blackpool, Fylde and Wyre Hospitals FT

Background

In 2006/07 at 28% the caesarean section rate in Blackpool was the highest in the North West, with a medical model for maternity care in place. The trust board was keen to see the maternity service’s improvement in caesarean section rates, from the perspectives of patient experience, quality, safety and cost.

The initiative was linked to the trust’s organisational strategy, The Blackpool Way, which focuses on effective employee engagement and high performance. As a result of changes in the organisational culture and a focus on normalising births, the caesarean section rate has fallen to 24%, while we have also increased the rate of vaginal births after caesarean (VBAC).

Realising the need to change the beliefs and behaviours of staff, changes to the management culture released the potential of staff to make changes. This work supports national policies that focus on:

  • Offering choice to women about where they give birth;
  • Increasing the percentage of women having a vaginal birth;
  • Increasing the use of non-pharmacological pain relief, in particular the use of water in labour;
  • Reducing the percentage of women whose birth is induced medically.

The process

The NHS Institute supported work to reduce the caesarean section rate. Improved training included normal birth initiatives, education about VBAC and improved training to monitor the foetal heart rate. We introduced VBAC clinics to explain to women that having had a previous caesarean section does not preclude them from having future normal births.

The trust has worked hard to normalise the birth environment, replacing beds with couches and beanbags. Following feedback from women, baths were added to en-suite rooms to help with non-pharmacological pain relief in labour. Although more staff intensive, staffing levels were increased to meet national standards and enable midwives to offer one-to-one care in labour.

A key change has been the introduction of a Situation, Background, Assessment, Recommendation (SBAR) board on which midwives and obstetricians write information relevant to each patient in the delivery suite. This provides a structured communication system and gives more junior staff a vehicle for making themselves heard.

Although they initially greeted the SBAR boards with scepticism, staff quickly realised their value and the system has been extended to handover between shifts and between wards, while other parts of the hospital are now adopting it as a communication tool.

Benefits of the initiative

A 4% reduction in the caesarean section rate equates to 82 fewer babies born by caesarean section each year, providing improved patient care and safety along with large financial savings. Local patient satisfaction surveys have demonstrated a significant improvement in how women rated their satisfaction of their maternity care, while a reduction in the length of stay following birth has enabled the maternity service to manage the increasing birth rate with no adverse effects to women and their families.

The maternity service has also reported continuing improvements in the results of staff satisfaction surveys. Reducing caesarean section rates and increasing successful VBACs (up from 50% to 65%) has created a palpable sense of pride. Staff confidence, particularly among more junior staff, has increased and we have moved from a culture of anxiety to one which is proactive in encouraging VBACs, but that also accepts that intervention is necessary in some instances.

Financial implications

The initiative incurred no financial costs as it was achieved through staff enthusiasm and commitment to improving patient care. The reduction in caesarean section has given significant financial savings — normal delivery costs £752 compared with £1,100 for a caesarean; 82 fewer of these procedures has therefore saved almost £29,000.

Contact

For more information on this initiative please contact Pauline Tschobotko: pauline.ts@live.co.uk

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