Online feedback in maternity care as a stimulus to quality improvement

Over the past year Care Opinion has worked with the improvement consultancy Elliott Blanchard to develop an innovative model of quality improvement within maternity services at Pennine Acute Hospitals NHS Trust. The aim was to develop a culture of listening, learning, quality improvement and collaboration, co-designing improvements based on feedback, following a critical CQC report in 2016.

In this blog post, each of the three partners gives their own perspective on the activity and impact of the project.

Samantha Whelan, patient experience midwife, Pennine Acute Trust

The women and children’s division at the trust agreed to sign up to a pilot scheme with Care Opinion to give women and their families the opportunity to leave honest anonymous feedback about their experiences of our service. Positive stories about our service are always a pleasure to receive and we share them with staff. Critical feedback highlights the areas where we can improve, and we listen to all suggestions on how to improve our service. So now we have a simple mechanism for continued reflective learning, helping drive up standards within our service.

During the project I found time to gather stories from women every day, either online using our free Wi-Fi, or via a freepost leaflet. I was present on the unit to promote the project, which gave me the chance to speak to women directly and deal with any issues that they may have. It also increased the awareness of Care Opinion and the changes we made as a direct result of feedback, among all grades of staff.

I also used Twitter and our private staff Facebook group to share positive stories and the changes we made, which led to an increase in staff morale. So far we’ve heard almost 300 stories online, and made eight service changes as a result.

We have now created a maternity quality improvement forum, made up of midwives, managers, and women who have used our service. The forum will meet monthly for six months and tackle a quality improvement project based on the mixed feedback we received about partners staying over on our unit.

As my role has evolved I have had less time to spend on the wards, so to maintain awareness of Care Opinion and the flow of stories, we have created a new “ambassador role” for the maternity support workers (MSWs). This makes sense because MSWs have many contacts with women every day and can promote Care Opinion during their normal activity.

Lisa Elliot, director, Elliott Blanchard

At Elliott Blanchard our contribution was to deliver quality improvement training to a wide range of ward staff. This included taking time to look at data, how to understand data and how to use patient feedback when doing improvement work. We wanted all members of staff at all levels to be involved in a co-design approach to improvement.

We also provided coaching and support for Sam, lead midwife for the project. Sam already had plenty of clinical experience and good working relationships with staff at ward level, so she could easily engage with them in developing the new approach. By coaching her in quality improvement methodology, how to engage stakeholders and how to create a campaign around creating a conversation with patients and carers, we helped ensure that the stories would lead to sustainable improvements.

We helped to identify which areas for change were “quick wins” and which would require a structured approach using quality improvement methods. Together, we established the co-design forum which included members from Healthwatch, service users, clinical staff and commissioners.

Tim Hunt, integration development manager, Care Opinion

Care Opinion came into this project as the chosen route for collecting and sharing feedback in public and near real-time. Our online platform makes it safe and simple for women and their families to share stories, and for staff to respond openly. Because our platform is available, tried and tested, we were able to respond quickly so that the momentum within the trust was not lost.

Our support team worked with Sam at the trust to make sure that maternity staff could log into Care Opinion to create alerts, respond to stories, receive monthly reports and create themed data visualisations. We shared best practice in how to respond to stories in ways which are authentic, personal and constructive, supporting the team as necessary to get the most from the platform.

Next steps

This project shows how a practical and thoughtful approach to working with online feedback can create genuine service change. It is heartening to see that CQC’s assessment of the maternity service published on 1 March 2018 notes: “The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff.”

At Care Opinion we now want to feed the learning so far into developing a sustainable model for the work in Oldham, which is also transferable other services and settings. To support this, we have created a Care Opinion pack for volunteers and staff to use on wards when encouraging feedback. We will also be running a workshop with maternity support workers to introduce the pack and test out its value.