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26 June 2015
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Perinatal institute leads the way in clinical leadership

We interviewed Professor Jason Gardosi, consultant obstetrician and director of the award-winning Perinatal Institute, whose pioneering team carried-off the BMJ Clinical Leadership Team of the Year award for its work in enhancing the safety and quality of maternity care.

Originally founded in 2000, the Perinatal Institute was established as an NHS hosted organisation to address the high rate of stillbirths in the West Midlands. The perinatal mortality rate in the region had been above the national average since records began, largely due to a mix of factors including social deprivation and poverty, smoking and large ethnic minority populations.

With the majority of stillbirths classified as ‘unexplained’, the first priority was to further investigate the causes.  In a key article published in the BMJ in 2005, the Institute reported that the majority of ‘unexplained’ stillbirths were in fact due to fetal growth restriction. So, they set up a large regional database for population-based research and demonstrated that most cases of growth restriction were not recognised antenatally, but that better antenatal recognition could indeed lead to significant reductions in stillbirth risk.  

From this, the Institute devised training programmes and tools, including growth charts customised to individual maternal characteristics to better measure and audit fetal growth rate during pregnancy. Their dedicated team of specialist midwives are now engaged by trusts and clinical networks to deliver workshops for service providers with the aim to improve antenatal detection of growth restriction.

In March 2013 the Institute was forced to close following the abolition of PCTs, their prime funding source. But, it was up and running again within weeks, after a dedicated core team, initially meeting in Prof Gardosi’s dining room, decided that the work needed to be continued. They reinvented themselves as a not-for-profit organisation, still based in Birmingham, but with a wider remit covering the whole of the UK.

Two years on, with a multidisciplinary team of 16 dedicated professionals and a clutch of national awards, the Institute has stable funding from over 100 NHS Trusts that have secured its services.

The cost of the growth assessment protocol (GAP) used to measure and audit fetal growth is 50p per pregnancy, or £2000 for an average size trust with 4,000 births a year. It is priced so that no finance manager can claim a shortage of resources as a reason not to engage when local clinicians agree that it is a priority. Organisations receive training, including individual hands-on and train the trainer workshops, a comprehensive e-learning package, the customised growth chart software, as well as protocol templates and audit tools for ongoing assessment of outcome.

The Institute is working with NHS England to integrate this programme as a key element of the new stillbirth prevention care bundle, and is funded to roll out GAP across three northern NHS regions as the SaBiNE initiative (Saving Babies in North England).

They have recently upgraded their software tool for unit based standardised clinical outcome review (SCOR), which helps clinicians to learn and develop action plans from their own adverse outcomes and contributes to improvements in patient safety.

The team at the Institute has won three national awards in the past three years, initially for their work advancing patient safety and reducing stillbirth in the West Midlands to its lowest level ever, and now in recognition of their clinical leadership in reducing stillbirth rates in England to its lowest ever level.

When asked what the impetus was for entering this year’s BMJ Awards, and specifically for the Clinical Leadership Award, Prof Gardosi explains: “Stillbirth is in many cases an avoidable tragedy which still occurs too frequently. Change management – doing things differently – is such a challenge in the NHS. Even once you’ve got evidence on your side there are still hurdles and priority conflicts. This award helps to highlight the relevance of stillbirth, which is still too often surrounded by a conspiracy of silence. It gives added leverage to changing the remaining hearts and minds – the late adopters of innovation and those who are least confident in changing practice.”

In their citation, the BMJ Clinical Leadership judging panel, led by Professor Sir Bruce Keogh, commended the Institute’s work for its “quiet, relentless, determined leadership across a complex network of healthcare provision.”

To Prof Gardosi, good leadership is a visible process to remind clinicians of the very reasons they’re in the business of care in the first place. He says: “We have to challenge the premise that the institution and its systems are at the centre and cannot be challenged. For us it’s about putting mother and baby into the centre of the picture, then everything else follows and needs to be designed around it.”

He dedicates the award to the many mothers who suffered tragic losses from which the Institute has been able to learn, and to the increasing number of clinicians at the sharp end who are working hard to change and improve practice.

So, what’s next for the Institute? They have started to export their work and best practice models to other countries, including the Netherlands, New Zealand and India, but the NHS remains the main focus. Prof Gardosi explains: “We have reached two thirds of all trusts in the UK with information and training and now need to reach the remaining third. The least we can do is help clinicians find ways to continually audit their performance through adverse outcome reviews, so that evidence can support local champions to become leaders themselves.  

“It also makes sense that mothers become leaders in their own care. We want to empower them to be better informed and take more control. We are currently engaged in a project moving mothers from the traditional, paper based notes to electronic maternity records, carried on tablets and mobile phones, and fully inter-operable with community and hospital-based information systems.”

Finally, Professor Gardosi outlines where he and his team draw their inspiration: “That’s easy. When you’ve sat through case reviews, seen how easily mistakes are made and lead to avoidable tragedies, it’s the strongest motivation to want do everything possible to prevent them.”

FMLM is proud to support the BMJ Clinical Leadership Team of the Year Award and congratulates the Perinatal Institute on their exemplary leadership and achievement.

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