Example 4: Improving safety and quality through multi-professional training

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This is one of five examples from our report Making the case for quality improvement: lessons for NHS boards and leaders. Each example illustrates how quality improvement approaches are being used by teams and organisations in different parts of the NHS in England to improve care and value for money.

Practical Obstetric Multi-Professional Training (PROMPT): North Bristol NHS Trust

What was the problem? 

Good teamwork and communication between professionals are crucial in ensuring high-quality care and avoiding errors during obstetric emergencies. An awareness of the importance of effective teamworking has led to a shift in the focus of maternity staff training over the past 20 years towards approaches aimed at integrating teamworking within multi-professional clinical training to build supportive, well-functioning teams. A leading example is Practical Obstetric Multi-Professional Training (PROMPT) – a programme developed by a group of professionals based in maternity units in south-west England. It was first implemented at North Bristol NHS Trust in 2000 and has since spread to maternity units across the UK and around the world.

What did they do?

The PROMPT programme is based on the idea that teams that work together should learn together, and that the best place to learn is in the maternity unit itself, not on an off-site training course. At Southmead Hospital in Bristol, PROMPT consists of a one-day course involving a mix of workshops and team-based emergency drills, using patient actors and props in a clinical setting. Over the past 17 years, the course has become an established and highly valued part of the maternity unit’s practice. It has strong support from maternity, obstetric and midwifery leads, who are committed to ensuring that staff are released to attend the course and that there are enough trainers to deliver it.

PROMPT is designed to ensure that teams have the technical competence to respond in the right way in any given emergency: it is about making the ‘right way, the easy way’. But PROMPT is as much a social intervention as a technical one. The course helps teams to work together to identify and achieve their own shared goals and do their best for each mother and baby. It also seeks to foster a learning ethos within the unit, founded on a collective commitment to continuous improvement and critical reflection. One of the key behaviours that PROMPT seeks to embed is ‘problem sensing’, where staff use both real-time data and soft intelligence to spot emerging safety and quality challenges and review their practices accordingly. 

What impact has it had?

PROMPT has had a significant and sustained impact on Southmead Hospital’s perinatal outcomes. Since its introduction in 2000, injuries to babies caused by a lack of oxygen have reduced by 50 per cent, while there has been a 100 per cent reduction in permanent brachial plexus injuries to babies. By improving the safety of its service and the outcomes and care experiences of mothers, babies and their families, the hospital has also saved the NHS money. For example, litigation claims have gone down from £25 million before the launch of PROMPT to around £3 million in the 10 years that followed.

Implementing PROMPT has also enabled other hospitals around the world to improve clinical outcomes. For example, a number of maternity units in Victoria in Australia have reported some reductions in birth injuries, babies’ length of stay and litigation claims after introducing the programme. Nonetheless, it has not proven straightforward to replicate Southmead’s impact elsewhere. Research supported by The Health Foundation is currently under way to help understand what is needed to implement PROMPT successfully in different contexts. 

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