improvement intervention:

Lessons from scaling PReCePT (Prevention of cerebral palsy in pre-term labour)

• Antenatal magnesium sulfate (MgSO4) therapy given to women at risk of preterm birth reduces the combined risk of infant death or cerebral palsy. It is a recommended intervention by the National Institute for Clinical Excellence (NICE)

• The PReCePT Quality Improvement (QI) intervention was implemented by champion midwives in all maternity units in England and was found to be effective and cost effective in improving adherence to MgSO4 guidance [1]

The problem

Social impacts of QI interventions, e.g. staff wellbeing, are not routinely captured, but can impact on sustainability

Outcome

Being a midwife champion had an impact on work related wellbeing

If you’ve got fire in your belly then you bring that back to the workplace (P16 )

What we learned

I really enjoyed doing it and I'm really glad that I went for it […] It's really got my confidence up (P17)

Elements of the intervention, characteristics of the organisation, and the perinatal team, impacted on champions’ work-related wellbeing

1. Champions believed in PReCePT’s role in improving care. There was a lot of commitment and enthusiasm to make it a success. Mentoring, co-creating learning, and being part of a community of practice enhanced self-efficacy, confidence, and led to more career opportunities

2. Support from the organisation through backfill funding, access to resources, and clinical managers and matrons allowing champions time off clinical duties, helped champions feel recognised, supported and committed

3. Champions in settings where PReCePT was a perinatal team intention, described improved team competencies , felt pride in collective achievement, and improved morale and job satisfaction

Midwives [ ] should be given more opportunity to be involved in this because it does give you a really good background and it gives you the confidence to deliver care (P15)

What did we do?

Qualitative process evaluations of the National PReCePT Programme, and the PReCePT Randomised Control Trial (PReCePT Study)

What were champion midwives’ views and experiences of implementing PReCePT?

How did we do it?

Semi-structured telephone interviews with 22 midwife champions from enhanced & standard support units Interviews were audio-recorded & transcribed with consent

• Analysis using the framework approach [3] and informed by the Normalisation Process Theory [4]

Conclusions

• Allowing opportunities for midwives on the ground to take more active roles in QI, and making QI a collective cross-disciplinary endeavor, can have an impact on staff wellbeing, and built improvement capability within the organization

• Job satisfaction and improvement capability are crucial for improving quality of care and retaining staff. Adequate backfill funding for champions and organisational support for QI activities are essential for achieving maximum impact

I had really good support from my matron and the lead for the labour ward, everyone was very supportive […] I'm quite lucky at the unit, everyone is very keen to learn new things […] So for me, it was a really good experience (P17)