Postnatal care is vital for the safety and wellbeing of mothers and babies yet it does not always meet their needs. The Better Births report1 included its improvement as a key recommendation. Midwives and managers are currently challenged to improve both quality and efficiency of postnatal care.
Description
PRAM is a decision-support tool for transparent, evidence-informed decisions about organisation of postnatal resources, providing feedback on costs and quality of care options. Research and local service teams collaborated to redesign postnatal care using PRAM in one maternity service in England as follows:
1. The vision: To improve women’s care through enhanced maternity support in the postnatal period.
2. Assessing our current service: collect baseline information through audit and pathway mapping.
3. Appraisal of options. Four service design options were considered. PRAM feedback enabled discussion and a decision on our preferred option.
4. Implementation action plan to -reduce length of inpatient stay for suitable women to <24hrs, specified minimum number of community care contacts, a first community midwifery contact at home for all women, improving continuity of carer, offering home postnatal care to women with complex needs and clinic venues for others, offering all women 2 additional MCA infant feeding/support visits.
5. Implementation using LEAN methodology2. Revision of systems and processes, audit and remodelling community midwifery services into teams to coordinate women’s care in geographical areas.
Discussion
The new model is anticipated to reduce inpatient stay and readmissions, increase breast-feeding rates on discharge to health visitor, women’s experience and continuity of carer. Costs may increase by £48 per woman. Evaluation will take place between May – August.
Conclusion
Using a modelling tool aided transparency and facilitated discussion of issues and values within a multidisciplinary forum. The visual impact of options enabled trade-offs until consensus was reached. This meant buy-in from service leads who accepted the extra cost because changes are evidenced-based and based on local need.
1. NHS England. Better Births: Improving outcomes of maternity services in England. A Five Year Forward View for maternity care: National Maternity Review. NHS England, London. 2016.
2. Lean Change Management. http://leanchange.org/
1. Studies that integrate knowledge from a range of scientific approaches and/or perspecti , Studies of and contributions to practice and/or service organisation , Methodological innovations inthis and associated areas
