Introduction:

In response to concerns highlighted by the Ockenden Report [1] and East Kent Maternity Services Report [2] healthcare organisations are seeking innovative strategies to address deficiencies in service delivery. This, coupled with a Care Quality Commission (CQC) report of a large Trust’s maternity services, revealed several significant shortcomings in maternity care, including failures in teamwork, professionalism, and communication.

Methods:

A workshop-based approach utilising simulation was informed by an extensive fact-finding process, involving one-to-one and group interviews with consultants, midwives and managers. This ensured a comprehensive understanding of the issues raised in the national and local reports and facilitated the customisation of scenario-based simulations to address specific areas of concern. Two separate site three-day workshops consisted of scenario-based simulations with actor role players using adapted forum theatre techniques with debriefing, reflection and action planning. Demonstrating support for the principles and values agreed by the extended team was essential; this included appreciating shared values and common goals, being open, honest, showing mutual respect, trust, kindness and feeling comfortable to be heard but also listen, and challenge.

Results:

Feedback from participants and data collected during the simulations indicated a positive impact on participant understanding, confidence, and skills. Participants reported improved awareness of the issues highlighted in the reports and expressed increased confidence in their ability to address them. Subjective outcomes were:

● 58% increase in feeling comfortable to initiate a challenging conversation with a more senior colleague.

● 83% increase in the perception that by not starting a challenging conversation with a colleague the individual takes no responsibility to improve the culture

● 60% increase in the ability to listen actively to others when an issue affects them directly and their viewpoint is different.

Discussion:

Utilising simulation in the development of a local response to the Ockenden and East Kent maternity services reports proved to be an effective strategy. Two simulation-based ‘I’ categories were identified: inclusion and identification [3]. This was a valuable opportunity for participants, as key stakeholders, to practice and refine their skills in a safe environment, and, through simulation, to identify, discover and recognise what was happening for them in their unit. Discussion was rich, honest, challenging and illuminating. This approach holds promise for replication in other healthcare settings seeking to address similar challenges in service delivery and quality improvement.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

References

1. Ockenden D. Ockenden report - final [Internet]. GOV.UK. Crown; 2022. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1064302/Final-Ockenden-Report-web-accessible.pdf.

2. Kirkup B. Maternity and neonatal services in East Kent: “Reading the signals” report [Internet]. GOV.UK. 2022. Available from: https://www.gov.uk/government/publications/maternity-and-neonatal-services-in-east-kent-reading-the-signals-report.

3. Sharon MW, Buttery A, Spearpoint K, Kneebone R. Transformative forms of simulation in health care – the seven simulation-based ‘I’s: a concept taxonomy review of the literature. International Journal of Healthcare Simulation. 2023.