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Maternity Services Liaison Committee (MSLC) ‘walks the patch’ to reflect the views of users

By Professor Jacqueline Dunkley-Bent head of midwifery education at London South Bank University and Hazel Jones, the former joint chair of of the Maternity Services Liaison Committee at Guy’s and St Thomas NHS Foundation Trust.

Midwives online: Oct/Nov 2008

 

Introduction
Maternity Services Liaison Committees (MSLCs) play a significant role in influencing and guiding the development of maternity services and are a vehicle for change and improvement (Edwards, 2005). They have the potential to contribute significantly to maternity strategy, guidelines and policies, patient information services, clinical services and commissioning plans, if there are systems in place that facilitate the process (Department of Health, 2006). For example, ensuring that relevant items are placed on the agenda for MSLC meetings and time allocated for discussion and feedback to ensure that the user view is represented. Alternatively, MSLC user representatives may be invited to contribute to or become members of guideline development groups. Contributing in this way, with clear feedback mechanisms to the MSLC regarding the activities of its members helps to demonstrate that their contributions are valid and taken seriously, thus enabling committees to be proactive and worthwhile.

 

This paper describes the process by which one MSLC of a London hospital seeks the views of ethnically diverse and vulnerable groups who use maternity services, but who are not members of the MSLC.

 

A need for change
The MSLC of a large maternity service in London serves in parts socioeconomically disadvantaged and ethnically diverse communities with higher teenage pregnancy rates than most other London boroughs. It struggled to seek the views of women from these groups and discussed proactive ways of doing so. It was recognised that despite providing incentives like crèche facilities, a healthy two-course lunch and remuneration for travel, many women were unable to commit to joining the committee, particularly those from minority groups. The MSLC’s mission statement (see Figure 1) refers to good channels of communication between users of the service and those who provide the service. The reality of this regarding communication with vulnerable women was not always apparent, particularly when trying to establish representative views of diverse communities whose views should be heard, acknowledged and respected. 

Engaging the views of users who reflect the local population was considered key to the success of the committee - the legitimacy of a combined approach is well researched and evidence shows how beneficial involving service users in service provision can be.

Baxter (2006) states that the views of current and recent users must be established and special efforts to seek the views of women and men who may find it more difficult to access services or have their views heard must be made. This may include black and minority ethnic groups, travellers, refugees and asylum seekers, lone parents, teenagers, women with disabilities, families on low incomes and other marginalised vulnerable groups. 

 

Figure 1. MSLC mission statement of a maternity unit in London.

All parents having a baby should experience high-quality care in a centre of excellence. As a team of parents and professionals we will monitor care, maintain improvements and motivate change. We will ensure that staff participate in and support the work of the MSLC ensuring that the advice given contributes to developing services. One of our key priorities is to ensure good communication links between the MSLC and the multidisciplinary forums where professionals and users can monitor and improve the safety and quality of maternity services.

 

Time for Action

Schott and Henley (1996) state that every member of the MSLC must take responsibility for helping to achieve equal access embracing a collaborative, transparent approach when seeking new members. With this view in mind, consideration was given to patient satisfaction surveys, collaboration with parent forums at local Sure Start Children’s Centres, teenage mothers and community organisations. With little success and no new members, it was agreed that the committee would focus on an activity that provided one-to one, face-to-face contact with women and their partners from all backgrounds, at which time their views of maternity services would be sought and recruitment to the committee encouraged. This activity was called ‘walking the patch’, which means visiting clinical areas and speaking to women and their families when appropriate about the services they received. It was thought that this would provide the greatest reach to vulnerable groups while making appropriate use of the user representative’s time.

 

Walking the patch process and outcome

It was agreed that this activity would be   facilitated by the user representative members of the committee, with support from midwifery managers. To make the most efficient use of time, the activity was planned to take place one hour prior to each MSLC meeting.  Crèche workers were booked to accommodate the extra time user representatives were away from their children. Identification badges were produced and a rota for ‘walking the patch’ was developed. A user representative agreed to do this activity prior to each MSLC meeting. A guidance sheet was developed (see Figure 2) to assist user representatives to carry out the activity, and staff within maternity services were informed.

 

To ensure that the activity ran smoothly a named midwifery manager formed part of the rota to assist the user representative in gaining access to the clinical areas and ensure that a briefing about clinical issues that might impact on the visit took place. The manager would then leave the user representative to meet with women, carefully ensuring that she was not part of the meeting. Each user representative would try to visit at least  two clinical areas within one hour. One-to-one and sometimes group discussions took place with women and their families if they were present. The areas visited included the antenatal clinic, antenatal ward, antenatal day unit, fetal medicine unit and the postnatal ward. The birth centres and the neonatal unit have recently been included on the rota for visiting.


 Feedback to the MSLC

The process of feeding back the views of users was timely and occurred immediately after ‘walking the patch’ had taken place. The MSLC was a multidisciplinary group and included user representatives, midwives, midwifery managers, a consultant obstetrician, a consultant neonatologist, the chair of the primary care Trust (PCT) professional executive committee, who was also a GP, a supervisor of midwives, a non-executive director and a student midwife. ‘Walking the patch’ feedback was considered to be a high priority and was a standard agenda item.

At the meeting, the user representative presented her findings to the committee, which sometimes involved quoting and paraphrasing women’s views. Feedback usually included a range of compliments, complaints, concerns and suggestions about improving women’s experiences. These were discussed at the meeting with a view to seeking resolution. This process sometimes involved managers feeding back to the respective clinical areas at ward meetings or suggesting corrective actions to the MSLC. If corrective actions were suggested the manager would implement actions within their respective clinical areas and feedback the progress of implementation at the next MSLC meeting. If comments made by women and their partner’s related to clinical guidelines or user information leaflets, this would be detailed to the chairs of these groups for discussion and action.

 

'Walking the patch’ user representatives comments

 

User representatives have expressed how useful they find ‘walking the patch’ and how useful they feel the activity is. Frequently cited comments and quotes include:

 

‘At last I feel that I am actively participating in making difference.’

 

'Staff were respectful of the need for confidentiality between the user rep and family being interviewed.’

 

‘Good opportunity to meet a truer cross section of the community.’

 

‘So good to know that my children were well cared for and that I had dedicated time to really focus on listening to the views of current users.’

 

‘Fantastic to meet mothers in the early postnatal period, and also some mothers antenatally, to hear about their experiences first hand.’


‘Great to hear how things are experienced by partners - their needs are so often unacknowledged at this precious time.’

 

Figure 2. ‘Walking the patch’

Guidance for ‘walking the patch’

The visit

Ward managers should brief user representatives regarding which patients are physically and psychologically well to meet. Participants can then:

 

  • Introduce themselves

  • Provide a description of the MSLC,   including its aims and objectives.  Representatives may wish to say something along the lines of the following:


The MSLC aims to promote and  develop maternity services here and is committed to improving the overall quality of care women and their families receive. The committee provides an opportunity for you to have your say about maternity services and is jointly chaired by a user representative and the head of midwifery and women’s services.

  

One can then go on to:

 

  • Explain the reason for the visit to the clinical areas

  • Make reference to the MSLC leaflet (carry a few copies with you)

  • The following questions may be posed:

 

– What do you think of the service you have received during your pregnancy, labour and postnatal period so far?


– What do you think are the most positive things about the service you have received?


– What areas do you think could be improved?


– How do you think these areas could be improved?


– Can I feed your views back to the MSLC?

 

NB. Any woman or their partner who expresses a wish to join the committee should be given  information about how to join

 

Achievements
Since the inception of ‘walking the patch’, the MSLC has transformed from being a relatively passive committee to a proactive responsive committee, where the voices of vulnerable women are heard and taken seriously. During 2007 ‘walking the patch’ occurred five times. During this time 30 women, five of whom had their partners present, were approached to offer their views of maternity services. Of this number, 50% were from vulnerable groups (including teenagers, those classified as homeless and refugees). Table 1 details the nature of all feedback received and has been summarised using thematic analysis, which is a method for identifying, analysing and reporting themes within data (Daly et al, 1997).


Table 1. Feedback from 'walking the patch'

Themes identified 

 

Action taken

 Excellent  praise

for the care

received from

midwives

and doctors,

several midwives

and doctors named

as being excellent

practitioners 

 

 

Shared with

maternity service team and

individual team members who

were named

 

 Birth stories told

  Positive themes and

areas for improvement fed back to the maternity team

 

  General views relating to

food portions being too small

 

  Feedback to catering

department, ongoing

discussions with the team who serve food

  Requests for decaffeinated

coffee by mothers breastfeeding

 

  Discuss with catering

department and orders amended to reflect this

  Conflicting information

received during the antenatal period

 

 

 Discussed with team members

 Request for more information

leaflets about services and

organisation of services

 

 Development of service organisation information

 

Limitations identified and plans for the future

As the first anniversary of ‘walking the patch’ draws near some valuable lessons have been learned, which will help to improve the way the committee reflects the views of users. It has been recognised that while the views of a wide range of users from different ethnic and social backgrounds were sought, this occurred either antenatally or soon after birth and did not reflect community care provision. In addition, it can be argued that women and their families need more time to reflect on their experiences, prior to being asked their views.

Future plans for ‘walking the patch’ include visiting women at home, which would ensure that women who had a home birth were included. Because the committee holds two meetings per year within a local children’s centre, ‘walking the patch’ in the hospital setting at these times does not take place. There are, however, plans to walk a small patch of the community, visiting two homes prior to these meetings taking place. This requires careful planning as issues related to time, availability to travel from home to home, resource implications and safety issues are paramount and as such discussions are still underway.

 

Conclusion
The authors believe that this MSLC plays a valuable role in involving service users in the planning and improvement of maternity services, and robust mechanisms are in place to ensure that this activity remains a reality. Despite the fact that, at present, the committee does not reflect the ethnically diverse community, MSLC members have been proactive in ensuring that a representative view of all cultural groups are heard. ‘Walking the patch’ has been a success, but members are constantly striving for improvements and the MSLC will work on the lessons learned to ensure that the committee remains proactive in its role of improving maternity services.

 

References

Baxter C. (1996) MSLCs - Developing effective black and ethnic minority representation. Changing Childbirth Update 6: 12-13.

Daly J, Kellehear A, Gliksman M. (1997) The Public Health Researcher: A Methodological Approach. Oxford University Press: Melbourne.

Department of Health. (2006) National guidelines for maternity services liaison committees. HMSO: London.

Edwards N. (2005) Promoting public participation: MSLC Workshops. AIMS  17(2): 16-17.

Schott J, Henley A. (1996 ) Listening to the voice on the minority group. British Journal of Midwifery 4(11): 601-7.