Improvement of Maternal Risk Assessment

In the provision of holistic and quality healthcare in the UK, the National Health Services (NHS) meets challenges especially when it comes to the provision of services to ensure excellent patient experience. While always looking for ways to reduce cost, the NHS faces many difficulties even as clinicians identify new ways of working to improve outcomes. Because of the many changes and challenges facing the maternity section in healthcare provision, the NHS is investing in effective leadership to support the changes that happen so frequently(National Institute for Health and Clinical Excellence, 2007). The nurses and midwifery staff are fundamental in leading innovation in the maternity section because they have a significant influence over others in the department. Therefore, improving the patient experience using appropriate frameworks and tools would help establish the change and fulfill the vision of the NHS in ensuring quality and affordable healthcare (National Improvement and Leadership Development Board, 2015).

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Statistics show that early identification and management of the risks associated with pregnancy is essential in the provision of optimal treatment to expectant women. Thus, six areas are necessary for the improvement of maternal care. These areas include stillbirth, sepsis, hemorrhage, venous thromboembolism, smoking cessation, and proper and appropriate induction of labor.

Changing and improving maternal risk assessment timelines and maternal care, in general, requires leadership initiatives. This is because the valid identification of maternal risk and its subsequent management is guided by nationally recognized evidence and best practice. Despite that, availability of evidence and practice guidelines from different authorities can overwhelm the health staff. Consequently, they may miss vital clinical factors. Even though risk assessment should always be carried out in advance, it is not still appropriately undertaken. Thus, this project proposes an engagement of the pregnant women and maternity staff at early stages of pregnancy in developing new ways of identifying and managing the risk associated with pregnancy. Thus, the project shall involve the creation of a community-based model meant to improve outcomes for women and their families.

The creation of the right environment for change require guidelines that will lead to a new culture (NHS Institute for Innovation and Improvement, 2010). The guidelines will help pregnant mothers and the maternity staff with the techniques, tools, and support that will enable them to take the lead and improve risk assessment for expectant mothers. This will entirely depend on the cooperation between the two groups (Waligo et al., 2013) to produce the best outcome (NHS Institute for Innovation and Improvement, 2010).

After the identification of the change, stakeholders and their roles and responsibilities, the next stage involves breaking down the project into clearly identifiable tasks known as an action plan (Appendix 2). The program, which identifies how objectives will be achieved and by whom, organizes the process into manageable sections (NHS Institute for Innovation and Improvement, 2010). Creative thinking can support the development of an action plan as it will enable the leader to discover creative ways of completing tasks (NHS Institute for Innovation and Improvement, 2010; Grol, 2013). Once the functions have been identified, target dates are applied which shows the schedule for completion. Appropriate allocation of time to create change should be considered to avoid frustration amongst stakeholders (Grol, 2013). Changes to patient care often take longer than other projects as satisfaction is evaluated regularly, meaning that clinical outcomes and short term goals often require adjustment (National Institute for Health and Clinical Excellence, 2007; Grol, 2013). Following completion, the action plan is displayed for stakeholders to view on a regular basis which supports frequent meetings to monitor progress and allows for stakeholders to feedback and ensure the project stays on track. This identifies potential problems that occur, (NHS Institute for Innovation and Improvement, 2010; Grol, 2013) and enables the CNS to solve problems proactively.

Communication is the fundamental strategy to successful change (Doherty et al., 2014). Regular face to face discussion and listening to stakeholders is priority to ensure they have the freedom to speak openly (Parkin, 2010) which will persuade, sell, negotiate and motivate them to come on board with the innovation (Parkin, 2010; Doherty et al., 2014) leading to successful engagement (Pater et al., 2012). Communicating the vision and being transparent about the change and action plan promotes an engaged workforce (Kumar, 2015; Hopp, 2016) which assists the CNS in the delegation of tasks. Appropriate delegation of functions is crucial for nurse accountability. The Nursing and Midwifery Council Code of Conduct (NMC, 2016) give specific instructions on commission which highlights the need to lead this process correctly. Inappropriate delegation can have a negative impact on change (Curtis et al., 2004; Rees et al., 2015). Therefore, the CNS will ensure tasks are fair and make herself available to support and assist with challenges when needed. Effective delegation can be difficult in healthcare due to inadequate staff, increased responsibility/workload, budget restrictions and time (Curtis et al., 2013; Rees et al., 2015). When all the necessary steps in planning have been made, implementation can begin.

Following implementation of the change, the evaluation would be critical to determine if the change has led to the desired outcome (Grol, 2013). Short term goals will have been monitored by regular review of the action plan. However, the effect the change may have on patient experience, satisfaction, bed availability and cost is a long-term goal that requires evaluation through feedback forms with parents and stakeholders. Clinical outcomes would be assessed through records of births, postnatal care observation, and stakeholder feedback. Cost outcomes and patient/stakeholder satisfaction would be communicated to the broader care group through clinical governance.

Through completing a needs analysis and using the framework to guide the change in identifying stakeholders, action planning, monitoring and evaluating the project it has highlighted an innovative way to improve the patient experience. Leadership communication is defined as the key strategy used to motivate, engage, delegate and support those involved through the change process.


References (2019). Maternal Fetal Risk Assessment – [online] Available at: [Accessed 31 Jan. 2019].

Curtis, E., Honor, N. (2004) ‘Delegation: a key function of nursing’, Nursing Management, 11(4), pp.26-31

Doherty, T. Horne, T and Wootton, S. (2014) Managing Public Servies – Implementing Changes. Abingdon Oxon: Routledger. Second Edition. (2019). MCH Epidemiology: Pregnancy Risk Assessment. [online] Available at: [Accessed 31 Jan. 2019].

Grol, R. Wensing, M. Eccles, M. Davis, D. (2013) Improving Patient Care: the implementation of change in healthcare. Oxford: Wiley Blackwell

National Institute for Clinical Excellence (2007) How to Change Practice. London: National Institute for Clinical Excellence Available at: (Accessed: January 2019).

National Health Service Institute for Innovation and Improvement (2010) The Handbook of Quality and Service Improvement Tools. Available at: (Accessed: 31 January 2019)

Nursing and Midwifery Council (2015) The Code: professional standards of practice and behaviour for nurses and midwives. London: Nursing and Midwifery Council. Available at: (Accessed: 31 January 2019)

Parkin, P. (2010) Change in Healthcare Using Action Research. London: Sage

Royal College of Nursing (2015) Traction: principles and application. London: Royal College of Nursing.

The Health Foundation (2018). Maternal risk assessment: management by and with pregnant women | The Health Foundation. [online] The Health Foundation. Available at: [Accessed 31 Jan. 2019].

Waligo, VM., Clarke, J., Hawkins, R. (2014) ‘The Leadership-Stakeholder Involvement Capacity Nexus in Stakeholder Management’, Journal of Business Research, 67, pp. 1342-1352

Rees, D. and Porter, C. (2015) ‘Delegation – a Crucial but Sadly Neglected Management Skill’, Industrial and Commercial Training, 47(6), pp. 320-325. doi: 10.1108/ICT-04-2015-0030

Needs Analysis – Appendix 1

Date Reviewed Problems Identified
Survey Feedback from patient mothers
  • ‘I was not prepared for the caesarian section to deliver.’
  • ‘if only I could get the information earlier, my baby would be born alive.’
  • Stillbirths
  • ‘painful induction.’
  • post-partum hemorrhage
Verbal feedback from Mid-wives
  • post-partum hemorrhage
  • we could not arrest the situation
  • we had to recommend CS action
  • she did not come for regular clinic check-ups
  • the baby was born dead (stillbirth)
  • the baby was deformed and physically unable
  • abortion would have saved the mother earlier
Reports from hospital administration post-partum hemorrhage, stillbirth, sepsis, venous thromboembolism, smoking cessation, and appropriate induction of labor

Action Plan – Appendix 2

Objective Actions By Whom When Challenges
Gather evidence to support the proposal Contact previous patients

Review friends & family feedback

Review former patient ultra-sound images

Review Maternity reports

Review current literature

Leader ( Certified by Nursing and Midwifery Council) 4/60 Time consuming, broad UK literature, delay in response from families, confidentiality guidelines by the NHS
Discussion with the Maternity Team Present evidence collected

Make decisions to take the proposal forward or not

Leader( Nursing and Midwifery Council) 6/60 Arranging a suitable time to meet
Identifying and communicating with stakeholders (NMC, NHS) 1. Initial discussion with stakeholders on a proposal to ensure inclusion from the start Leader (CNS) 4/8 Concerns over increased workload & learning new skills
Maternity and Children Pediatric Team to write inclusion/exclusion criteria for Risk Assessment procedures Evidence from objective one available

Equipment list

Risk assessment form

Set up of relevant equipment like ultrasound (who & when)

Leader (CNS) & nurse consultant 8/60 Arranging a suitable time to meet everyone’s need
Finalize inclusion protocol Prepare document

Send to the team for approval

Leader (CNS) & stakeholders 14/60 Time


Present protocol at clinic governance (including care group) Prepare a presentation

Present inclusion/exclusion document, revised pathway

Team available to answer questions

Leader(CNS) & nurse consultant

CNS, nurse consultant

18/60 Old school thinking, why do we need to change?

Who takes the lead if issues arise outside regular working hours?

Write Business Case Need for development, cost-benefit, costing of the proposal

Clinical benefit

Maternity cost

Care group business management team, clinical information guide from the leader (CNS) 20/60 Possible Emotional and Psychological breakdown due to early closure of negative information
The business case for service change submit to (Clinical Commissioning Group- CCG) Await approval Care group business management team Two months for approval estimated Long process possible loss of interest from others.

Possible cost implications

Hold Approval meeting with CCN team Inclusion/exclusion criteria discussed

Identifying training needs (maternity teaching, equipment, risk assessment

Discuss maternity visits (why, when, how and who)

Review of maternal risk assessment procedures and standards existing

Discussion of emergencies

Leader (CNS), nurse consultant 50/60 Lack of interest, difficult to get everyone together at the same time

May identify unexpected problems

Hold Approval meeting with Emergency department Inclusion/exclusion criteria discussed

Ambulance team requirements

Identify training needs – transporting from home to hospital

General nursing and midwifery training

Leader (CNS), nurse consultant 50/60 Complains of increased roles
Consultation with the hospital parent panel Face to face meeting with members of the parent panel to discuss home care Leader (CNS) & nurse consultant 46/52 Lack of knowledge, to much pressure on the family?
Produce parent/career information leaflet Maternity and its treatment

Emergency details & general contacts

Approval from maternity team, CCN’s midwifery & hospital patient information officer

CNS, nurse consultant, Consultant 40-50/60 Time consuming task
Prepare parent/family – training for maternity care The basics of safe maternity and midwifery care

Maternal risk assessment

Contact details for follow-up of expectant mothers

How to respond to emergency services

CNS, nurse consultant, CNS team 40-50/60 Maybe additional work for nurses entire maternity department


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