AcknowledgementsLisa Kennedy: Cluster General Manager Eurobodalla / Project Sponsor

Judith Hallam : Manager, Redesign & Innovation

Leanne Ovington: Director Nursing and Midwifery

Amanda Gear: Clinical Midwifery and Maternity Risk Management Consultant

Maree Hatton: Clinical Midwifery Consultant

Johanna Burke: Maternity Unit Manager, Western NSWLHD

Judith Yeo: Team leader Western Midwifery Group

Elizabeth Bennett: Maternity Unit Manager, Broken Hill

ConclusionThe project team acknowledged the importance of engaging stakeholders in planning and decision making. Collaboration and communication is key to engagement and commitment. Awareness of the various midwifery models of care and the importance of Triple Aim have improved. SNSWLHD is the only NSW health service that does not offer continuity of midwifery care. The potential for implementation aligns with state-wide “Towards Normal Birth” key performance indicators which are woman and family focused.

Case for ChangeWomen want a known midwife

SNSWLHD is the last LHD in NSW to offer a midwifery led Continuity of Care (CoC) model for pregnant women.

CoC models have proven increased satisfaction with experience of health care.

Attracts workforce, reduces complaints.

Women currently repeat their story to multiple clinicians.

Women have 1 – 2 home visits with a midwife.

Breastfeeding rates markedly decline from 93% to 31% by 4 weeks.

Diagnostics• Information given to women not standardised.

• Clinical practices not linked to policies, guidelines.

• Women see average of 16 clinicians during pregnancy

continuum.

• Average length of stay for normal vaginal birth higher

in our LHD than others of a similar size.

• Postnatal care limitations in service delivery.

• Declining breastfeeding rates:

Eurobodalla Birth PartnersWomen having a known midwife for continuity of care

Claudia Stevenson, Wendy Pryke, Angela McClelland, MUM Project Lead, CME RN/RM Project team, RM/RN Project team SNSWLHD Eurobodalla

GoalTo improve the experience and outcomes for women and their babies, ensure cost effectiveness, implement best practice models and maximise staff satisfaction.

Objectives( By August 2018 )

• Increase postnatal care > 14 days from 1% to 30%

• Improve the length of stay from 2.4 days to 1.2 days • Rates of breastfeeding at 6 months to increase from 15% to

30%

Sustaining changeEnsure aligned with Towards Normal Birth

Keep woman’s voices strong through stories,

midwives collect 2 x monthly and share

learnings at Team meetings

Continue steering meetings with consumer representative monthly

Significant change for midwives – implement evaluation checkpoints

Link PPADs with expectation of Models Of Care (MoC), provide ongoing education and develop learning needs

Introduction of new MoC , position description

Collaborate with doctors around MoC and continue case discussions

Accurate staffing levels, monthly workforce planning framework

Regular clinical supervision

ContactClaudia Stevenson Claudia.Stevenson@health.nsw.gov.auContact Number: 02 44 74 1524

Results

“ The option to have one or a small group of

midwives would be amazing”

“ My problem was around

communication”

Develop scope and

change

Data analysis and site

visits

Consults with women

& stakeholders

AIM tools for

change

Women's stories

Process mapping

Staff interviews

Breastfeeding appraisal tool

Triple AIM

Women and Staff

ExperiencePopulation HealthCost per Capita

The aim of having a known midwife improves safety, effectiveness, woman-centredness, timeliness, efficiency, and equity by promoting communication and

trust with a woman, resulting in less litigation for the health service

Improved team collaboration between women and clinicians resulting in

improved healthy lifestyle outcomes(e.g. smoking cessation, healthy weight

range, drug and alcohol avoidance)

I have greater job satisfaction knowing

my women

I feel listened to and this makes me feel

empowered

Methods

Planning and Implementing Solutions

YEAR DISCHARGE 6 - 8 WEEKS 6 MONTHS

2013 - 14 93% 31% 15%

2014 -15 92% 32% 24%

2015 -16 91% 31% 15%

41% 99% 50%

Postnatal care ≥ 14 days

ACM Guide lines BFHI

Education

0% 30% 20% Site visits attended by project team

Cost benefit analysis for executives

Clinical framework development in

progress

New policy guidelines in line with clinical

practice well in progress

Midwifery competencies excel

spreadsheet

Midwives using electronic documentation

for planning care

Creative rostering implemented with

postnatal home visits

“ I wishsomeone was here…”

Getting to know women and their

families is life changing

Standardise Information Given

to Women

Develop Midwifery Education

Establish Caseload Model of Midwifery Care

Increase Number of Postnatal Home

Visits

Align Clinical Practice to Policies

• Resource kit• Increase

clinical visits• Electronic

record of care plan

• Learning packages

• Update orientation package

• Onlinelearning access

• HR Systems• Caseload

rostering system

• OperationalPlan

• Promote model in community

• Union consultation

• Creativerostering

• Increase IT use for service contact

• Discharge pathway

• ‘When to call’ information kit

• Workshop on using NationalMidwifery Antenatal Care Modules and Australian College of Midwives’ Guidelines