Meet our Fellows: Improving professional wellbeing and patient safety through partnerships in midwifery

This is a story from our Fellows Tina Prendeville and Susan Barry about how our Improvement Leader Fellowship allowed them to explore new ways of working for midwives in obstetric units. Using quality improvement methodology and stakeholder engagement, the duo built meaningful connections with opinion leaders in their field and successfully piloted the Partnerships in Midwifery Study (PIMS).

Who are they?

Tina (pictured above left) is a Senior Research Midwife within the Women’s Health Research Centre, Imperial College London, and Imperial College Healthcare NHS Trust. Since her role as a NIHR Research Champion in Northwest London, Tina has gone on to work in reproductive health research, supporting foetal medicine studies to detect problems in pregnancy. In 2020, she completed her MSc in Genomic Medicine at Imperial College London.

Susan (pictured above right) is a Consultant Midwife at Imperial College Healthcare NHS Trust and has an MSc in Midwifery from University College Dublin. She is committed to the continuous development and support of midwives to deliver high quality maternity care.

Patient safety outcomes and healthcare worker wellbeing are intrinsically linked

Demanding working environments together with minimal support from colleagues can result in workplace stress that often negatively impacts on patient safety. Nationally, midwives are concerned about staffing levels, the quality of care they can deliver, and concerningly, over 50 per cent are considering leaving the workforce.

With this is mind, we worked as a duo to develop and test a concept which proposes establishing a partnership between two midwives. That is, a ‘shift partner’ to collaborate with during a shift in the obstetric unit or labour ward setting. The Partnerships in Midwifery Study (PIMS) is a new way of working, building on the work and standards established in one-to-one care in labour, one midwife to one woman or birthing person. In this case, however, it requires two midwives to two women or birthing people.

“Our primary objective for our improvement project was to enhance the working experience of midwives, resulting in improvement of overall care for women and babies by reducing stress, improving retention, and the professional perception of midwives.”

Tina Prendeville

Implementing an improvement project during a global pandemic

Our cohort took place in 2020, which meant we felt the impact of the pandemic on our project. Despite the pandemic and over a three-month period interrupted by the COVID-19 surge, we asked coordinators to pair midwives together during a shift and encouraged midwives to trial this new way of working.

“[Our] journey was at all times supported by the NIHR ARC Improvement leadership facilitators. [The programme team] were experienced, knowledgeable, supportive, and understanding. Especially as we were challenged by Covid. Many Fellows at different times were pulled away… for operational reasons, redeployment or family illness.”

Susan Barry

To gain an understanding of the impact of our project, we invited staff to participate in surveys and semi-structured interviews. We found ways to encourage greater engagement and increase accessibility of our measurement approach, such as offering paper surveys and online survey links using a QR code. Seventy midwives participated in our research and just over 80 per cent felt more supported when working in a partnership.

Lessons learned from the Fellowship

Throughout our project, we created a dialogue about PIMS with other midwives, both locally and nationally. Midwives were overwhelmingly positive about working in this way, when possible. Our project also allowed us the opportunity to discuss and identify other challenges midwives are facing in the workplace.

We would certainly recommend the Fellowship to those who are interested in innovation and change to improve patient care and professional wellbeing within healthcare. As Fellows, you have access to the experts within the NIHR ARC Northwest London team and presentations from external speakers in the context of structured training. There is a regular programme of interactive workshops and support to help you develop and implement your project. This is all delivered in a supportive and non-judgemental way by Drs Rowan Myron, Vimal Sriram and Fiona Moss .

During the Fellowship, we got to work with an interesting and diverse group of professionals, with shared goals and enthusiasm. Innovation in healthcare is not for the faint-hearted and is most definitely not a quick fix. As Fiona Moss said during one presentation, change is something you need to chip away at, slowly, and that has been our experience. However, just starting the dialogue is an acknowledgement that as health professionals we must continuously challenge the way we do things and work collaboratively with patients and colleagues alike. The most powerful lesson has been that connecting with people with shared passions and interests will always be worthwhile, even in this most difficult and unprecedented era.

“Innovation in healthcare is not for the faint-hearted and is most definitely not a quick fix. As Fiona Moss said during one presentation, change is something you need to chip away at, slowly, and that has been our experience… The most powerful lesson has been that connecting with people with shared passions and interests will always be worthwhile, even in this most difficult and unprecedented era.”

Tina Prendeville

Onwards and upwards: What next?

“Being part of the Fellowship gave structure and credibility to our project.”

Susan Barry

This platform gave us the confidence to reach out to experts in our field, start dialogue around dissatisfaction, burnout and why midwives are leaving the profession. As a result, we are currently working with a team of researchers designing a study that will evaluate how we implement complex change and the impact on midwives. This collaboration with an external academic team has been instrumental in developing a research grant application.

Apply for the Improvement Leader Fellowship

If anything in this post has inspired you, further information about applications to the NIHR ARC Northwest London Improvement Leader Fellowship can be found here.

You can keep up to date with our journey by following us on Twitter:

@TinaPrendeville

@SusieCath