WINNER - Changing Workplace Culture and Multidisciplinary Engagement in Maternity and Neonatal Clinical Risk and Governance

Hywel Dda University Health Board

Staff surveys by the General Medical Council (GMC) and Royal College of Midwives showed that workplace culture lacked psychological safety and there was a sense of fear regarding the clinical governance process. Keen to enable change, the Obstetrics and Gynaecology team at Hywel Dda University Health Board embarked on a quality improvement project to improve incident reporting rates and encourage multidisciplinary engagement with learning and reflection across maternity and neonatal services.

The team co-produced a sustainable programme which focused on systems learning and included the use of interactive and innovative training tools to enable the embedding of key themes and trends, without focus on apportioning blame to the individuals who have provided care. A new Risk and Governance framework was co-produced by a multidisciplinary team of midwifery, obstetric and paediatric staff to commit to a culture of systems learning with an aim to increase communication, collaboration and create an environment of psychological safety. Alongside this, the RCOG/RCM Escalation Toolkit has been implemented to enable staff to feel supported to escalate clinical concerns and take the opportunity to “teach or treat” to resolve conflict.

Following these changes in workplace culture, a recent Health Inspectorate Wales report in November 2022 stated that the unit was found to have a "Positive Culture around reporting and learning from incidents". The reviewers also found "there had been significant improvements made since the last inspection in 2019". There has been a 34% increase in clinical incident reporting, showing that staff feel safe to identify and report incidents they are involved in for wider learning.

The improved psychological safety and workplace culture has enabled staff to work more collaboratively and feel able to escalate more readily. This has had a positive impact on clinical outcomes with a significant and sustained reduction in the number of babies born requiring resuscitation. There has also been a consistently downward trend in the number of stillbirths.