Listening to feedback in maternity services

‘You don’t know you’ve got a good service, unless women are confirming that that’s how it felt for them’.

This sentiment was expressed by many of the people we spoke to as part of our research commissioned by the Department of Health, presented in the report User feedback in maternity services. It supports a principle well established across the NHS: that the experience of the service user is a key component of quality, and tracking that experience has an important role to play in monitoring services. For providers, understanding where users report poor experiences is key to identifying problem areas and shaping service improvements.

In the context of maternity services, the case for focusing on the experiences of women and their families is easily made; the birth of a child is a unique and life-changing event which can have a long-term impact on those involved. As the national maternity review noted, there are many factors – other than the final outcome – that determine whether or not women report a positive experience of childbirth. The critical relationship between experience and quality of care is clearly reflected in the review’s vision for maternity services; they must not only be safer but also ‘more personalised’ and ‘kinder’.

Of course, gaining a clear – and representative – picture of that experience is not straightforward. Collecting feedback from service users is one of the primary methods NHS providers have for doing this, and since the early 2000s there have been a number of centrally-developed tools in place to help them. In maternity services these include the Care Quality Commission’s maternity services survey (introduced in 2007), which collects feedback every 2-3 years, and the Friends and Family Test (extended into maternity services in 2013), which is designed to gather feedback in real time.

The good news is that many organisations have not stopped there. Our research, set out in our report, found that providers are also using a wide range of locally developed tools. These include methods for capturing unsolicited feedback, such as that provided in online forums, as well as more tailored approaches that proactively seek feedback from users, such as comment cards and maternity ‘graffiti boards’. At two of the organisations we spoke to, maternity services were participating in trust-wide ‘mystery shopper’ programmes, in which volunteers from within their user group were tasked with reporting back on their experience of key aspects of the service.

To gain the best insight into women’s experiences, organisations need to hear from as wide a range of users as possible. Our research found that those with the most developed approaches to feedback collection are using a wide variety of tools to help do this. This means ensuring there are tools in place to meet the needs of those who tend not to engage with traditional approaches, as well as methods tailored to the particular needs of the local population. For example, we heard about surveys developed in different languages, and a maternity services liaison committee (MSLC) run focus group aimed at vulnerable women.

In an attempt to strengthen providers’ ability to monitor service-users’ experience of maternity services, the national maternity review recommended that NHS England consider commissioning a set of measures equivalent to patient-reported outcome or experience measures (PROMs/PREMs), to ensure that information on experience is made available in a systematic way to both providers and commissioners. The review sets this within the context of a learning culture, in which teams, organisations and systems are able to access the information they need in order to improve.

Indeed, an important message from our research is that getting the most out of user feedback – or any insight into the users’ experience – relies on much more than effective collection tools or measures. Demonstrating that this feedback is listened to and acted on is critical in closing the feedback loop and ensuring that both users and staff remain engaged with feedback activities. This, in turn, relies upon organisations having a clear view of the purpose of feedback, leaders at all levels who champion these activities, and a culture in which the voice of users is valued as a driver for change.

How to make the most of user feedback is just one of the issues we will be discussing at our conference Shaping the future of maternity care in early November. The conference will bring together national leaders and innovative projects from across the country, demonstrating how local organisations are implementing the national maternity review's recommendations and giving women greater control and more choice. As local areas take forward the vision set out in the review, listening to and acting on user feedback should be high up their agenda.

And as Sarah-Jane Marsh, Chair of the Maternity Transformation Programme Board, has said in response to our report: 'True transformation of maternity services can only be done by listening to women and families, and understanding their experiences.'

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#548321 Catherine Williams
MSLC service user rep & NICE Fellow
Reading, Wokingham & West Berks Maternity Forum (MSLC)

Didn't look as though you had approached and talked to any of the service user groups on or the lay chairs of the very many active NHS multidisciplinary MSLC committees? If so, an odd omission. Try searching #mslc on Twitter. Did you talk directly to any service users at all? The national forum of MSLC service user reps could have helped you with that - to contact non-reps for input, as well as our network. Reading the report, it seems a bit disconnected from what is happening in maternity, always allowing for the fact that knowledge within trusts and CCGs of what is going on locally in maternity feedback sharing can be patchy. You might get a flavour of what is out there from the Reading MSLC filmed report - link on my blog

#548371 Lillie Wenzel
King's Fund

Catherine, thank you for sharing the link to your report. Our report describes the approaches to feedback (some of which involve MSLCs) that we heard about when we spoke to providers, but we’re aware that there are many other good examples. The scope of the commission from the Department of Health didn’t include discussions with user representatives, so unfortunately we couldn’t include this perspective in the report.

#548376 Catherine Williams
MSLC service user rep
Reading Woking & West Berks MSLC

Thanks Lillie. There is such a wealth of expertise out there in the lived experience of year-in, year-out feedback collection/review/co-design in MSLCs - as well as the linked governance aspect (see NICE CG190 recommendation 1.1.17). Multidisciplinary working as equals, lay and clinicians and commissioners together, is the key (and a model that can be seen as challenging sometimes - a challenge that NICE, for example, welcomes, in having a similar working group model.) MSLCs predate the current 'fashion' for co-design, and suffer perhaps from 'not being new' in an environment that favours 'innovation' - whereas maybe long term, sustained and sustainable effort is the real key. It is a real shame that the commissioning bit of Department of Health was not aware of the history - that service user reps can be experts too in matters of involvement and service change: it is a radical old idea.

#548384 Tony Sumner
Patient Voices Programme

In our experience, the most powerful thing about the stories mother tell is their expertise and their willingness to work with staff when there are problems - if they are treated with respect and honesty - see for example.

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