Case Study of Good Practice - Bronglais Hospital Maternity Unit
We want to ensure healthcare services reflect on our inspection and assurance work and measure their own services against these findings to drive forward service improvement. We hope the findings of good practice illustrated within this case study below can be transferred between organisations, and across the wider health service to support system improvements.
We conducted an unannounced inspection of the Maternity Unit at Bronglais General Hospital in Aberystwyth, run by Hywel Dda University Health Board. Inspectors completed the inspection across three consecutive days in August 2023, focusing on antenatal, labour, and postnatal care.
During this inspection, we found a dedicated team of staff, who were committed to providing a high standard of care to women, birthing people, and their families. Inspectors witnessed staff at all levels working well as a team to provide a positive experience, that was individualised and focussed on the needs of the women and birthing people they were providing care for.
Responses to our staff survey were positive, and this was reflected in the quality of care we saw.
Staff comments included:
Governance and leadership within the unit was highlighted as good practice, which had had a significant positive impact on the wellbeing of staff, and in turn on the quality of patient care and patient experience.
Inspectors observed staff providing kind and respectful care to women and birthing people and their families. When asked, all women and birthing people were positive about their care, the staff, and the maternity environment. We saw evidence that those with communication difficulties were identified and supported to effectively access services through the maternity passport scheme. The scheme can be used for those who are neurodiverse, and those with learning difficulties or any other communication difficulties,. to record communication needs of those receiving care. Inspectors witnessed staff speaking in Welsh and we were told by people using the services that the active offer of Welsh made a positive impact on their care.
Staff were also kept informed through internal newsletters to keep them up to date with new developments and events etc. We also saw evidence of a wide range of teaching and learning opportunities, including lunch and learn sessions.
Staff described a positive culture with good, supportive leadership. A clear management structure was in place with clear lines of reporting and accountability. Managers were visible, approachable, and receptive to feedback. There was a stable midwifery staff team with a strong team ethos and compassionate leadership. It was noted the unit did not experience some of the significant staff shortages that have been experienced elsewhere in UK. A range of supportive initiatives were in place to ensure that more junior staff members are supported by senior staff.
All staff told us they felt they could raise concerns to midwifery staff and consultants. This was achieved through a number of good cultural and governance processes. We saw a supportive culture around learning from incidents, such as the quick reporting of incidents, including those with no harm. Doctors and midwives led on sharing learning from incidents and communicating next steps widely. Themes were tracked and learning was encouraged through an open and supportive culture. Staff told us there was a culture of ‘closing the loop’, i.e. always fully responding to concerns and reflecting.
Further examples of good practice included the unit being part of the health board’s wider teams and networks, ensuring that the staff members who work in the smaller maternity unit are fully integrated and supported within larger networks.