Norfolk and Norwich University Hospitals

As Deputy Chief Nurse Yvonne Christley explains, “Norfolk and Norwich University Hospitals is absolutely and totally committed to delivering outstanding maternity care to women, babies and their families.”

The challenge:

To achieve outstanding care means making quality an intrinsic part of everyday processes –developing evidence-based metrics that span a mother’s maternity ‘journey’, from antenatal services, labour and birth, through to postnatal care. The challenges for NNUH in 2018 were:

• working with a cumbersome paper-based reporting system that was slow and admin heavy
• how to translate what excellent care looks like, every day, into a standard against which a ward or department or organisation’s performance can be measured
• finding a digital tool which would align closely to NNUH’s evidence-based metrics and maternity standards so everyone would use it
• having the ability to link metrics to the CQC domains and KLOEs (‘Key Lines of Enquiry’)
• having immediate access to information on the organisation’s performance at any point in time
• promoting transparency, accountability and assurance of quality.

The solution:
As Yvonne says, “Get the metrics right, and the benefits will be standardised measurements and processes as well as improved learning and development.” The maternity team’s solution was to work on the metrics, and implement the Tendable app as an easy to use, digital solution to reporting, which enables spotting trends quickly and improves staff engagement and accountability.

“By far the biggest benefit of using Tendable is its ability to capture everything visually,” says Yvonne, “and the tagging functionality is a great strength. At a glance, we can see all metrics for each part of the maternity care pathway, by division and across the whole organisation. It gives us rich and vivid data that is simple, and easy to interpret.”

The steps NNUH took to develop its metrics for use with Tendable:
The maternity care team made a conscious effort to use general Trust-wide quality measures as a foundation.

1. NNUH created a 10-strong team of professionals who pooled their different areas of expertise to build a joined-up set of metrics that would enable clinical teams to own, lead and drive their local quality improvement activities.
2. Front line staff were fully involved in conversations which produced shared decision-making regardless of ‘rank’.
3. Well-proven essential care disciplines, such as Infection Prevention and Control, Hydration, and Nutrition, were adapted for the maternity department.
4. Taking into account the existing NNUH maternity standards, policies, and research from the CQC and NHS Improvement, the team developed metrics for each of the three key elements of the maternity pathway: Antenatal, Labour and birth, Postnatal care.

It’s an approach NNUH Chief Nurse, Professor Nancy Fontaine believes is “establishing metrics that measure what is really necessary and meaningful”.

The result
In a short space of time, the innovative Tendable mobile app significantly reduced the administrative burden of performing audits, and transformed how staff at NNUH see their responsibility for improving quality.

• Audits can now be done in half the time
• the administrative burden has been eliminated; staff now have extra time to care for patients and support co-workers.
• processes are transparent,
• staff feel accountable and empowered to own quality improvement.
• The front-line team has truly engaged with the technology because they see audit results immediately and are keen to share their success stories.
• With live audit results, reports can be acted upon and improvements made without delay.
• Unleashes the true potential of nurses and midwives by making their roles easier and more efficient. Each member of the team is more engaged.

• A further benefit of Tendable is the ability to tag questions. “This means we have the ability to link any of our metrics and audits back to themes, for example the CQC domains or KLOEs. It’s so powerful when it’s up and running, we can report across whatever theme we like. Generating rich and vivid data from across the organisation.”

Professor Nancy Fontaine continues, “The impact of Tendable has transformed how staff see their responsibility for improving quality. The immediacy and ability to advertise great achievements and potential improvement is something the system does very quickly and easily. What Tendable also brings is assurance to the Trust’s Board, to myself as Chief Nurse, and to mothers, their carers and their families.

Next phase:
The next steps for NNUH is to run a larger pilot and gain valuable patient feedback by involving the mothers themselves. December 2020 saw the launch of the Maternity Department’s first Continuity of Care Team with the intention of having one full audit across the entire patient journey. Until now, nurses carried out their own audits for the mothers in their care, but the success of the new project has inspired the team to utilise audits as a valuable vehicle for sharing learning with colleagues and demonstrating what outstanding best practice looks like.