Queen Elizabeth The Queen Mother Hospital

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement, based on meeting the needs of women who used services and wider communities. We checked if leaders actively supported staff and collaborated with partners to deliver care which was safe, integrated, person-centred and sustainable, and to reduce inequalities.

At our last inspection we rated this key question inadequate. At this inspection the rating changed to good. Women’s outcomes were consistently good, and women’s feedback confirmed this.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty. The service was part of the maternity and women’s directorate. The leadership 'Quad' consisted of a managing director, the director of midwifery, associate medical director for women's health and a neonatal lead. The 'Quad' was also supported by the deputy director of midwifery and the head of midwifery.

There was a clear leadership reporting structure, and the team were supported by a deputy director of midwifery and head of midwifery on each hospital site. Staff told is the change in senior leadership had improved their voice in the department and they felt heard, and their opinions counted. The senior leadership team felt the executive team understood and supported their vision for the maternity service. Staff told us their ward managers; matrons and the head of midwifery were visible and approachable on the maternity unit.

Leaders were visible in the service for women and staff. Staff told us the consultant midwives were role models and examples of the good practice. All leaders worked clinically with the maternity unit team on a regular basis. This had improved communication and trust in the leadership team.

The maternity safety champion and non-executive director supported services to monitor safety and outcomes. Both were highly visible to the service and demonstrated a strong understanding of the challenges and opportunities the service faced. They undertook walk arounds of the department on a regular basis and often at weekends and evenings to ensure they had a rounded experience of the service.

The trust valued leaders and worked to develop the next generation of leaders in the organisation. During the inspection we met a member of staff who was part of the senior mentorship programme. This involved a band 6 member of staff shadowing a senior leader on a regular basis to gain experience and share learning.

There was a strong sense of pride in the service, hospital and community from our discussions with staff, Maternity and Neonatal Voices Partnership (MNVP), women and families.

The service celebrated staff and team success and supported good practice through meetings, maternity newsletters, a Broadcast Communication Channel and team away days.The service made a point of including student midwives from the local university, this investment in the relationship with students led to a majority of students taking up offers of work within the department once qualified.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty. The service was part of the maternity and women’s directorate. The leadership ‘Quad’ consisted of a managing director, director of midwifery, associate medical director for women’s health and a clinical lead.

There was a clear leadership reporting structure, and the team were supported by a deputy director of midwifery and head of midwifery on each hospital site. Staff told is the change in senior leadership had improved their voice in the department and they felt heard, and their opinions counted. The senior leadership team felt the executive team understood and supported their vision for the maternity service. Staff told us their ward managers; matrons and the head of midwifery were visible and approachable on the maternity unit.

Leaders were visible in the service for women and staff. Staff told us the consultant midwives were role models and examples of the good practice. All leaders worked clinically with the maternity unit team on a regular basis. This had improved communication and trust in the leadership team.

The maternity safety champion and non-executive director supported services to monitor safety and outcomes. Both were highly visible to the service and demonstrated a strong understanding of the challenges and opportunities the service faced. They undertook walk arounds of the department on a regular basis and often at weekends and evenings to ensure they had a rounded experience of the service.

The trust valued leaders and worked to develop the next generation of leaders in the organisation. During the inspection we met a member of staff who was part of the senior mentorship programme. This involved a band 6 member of staff shadowing a senior leader on a regular basis to gain experience and share learning.

There was a strong sense of pride in the service, hospital and community from our discussions with staff, Maternity and Neonatal Voices Partnership (MNVP), women and families.

The service celebrated staff and team success and supported good practice through meetings, maternity newsletters, a private telephone messaging group and team away days. The service made a point of including student midwives from the local university, this investment in the relationship with students led to a majority of students taking up offers of work within the department once qualified.

The service fostered a positive culture where women felt they could speak up and their voice would be heard.

Staff felt supported, respected and valued. Staff we spoke with during the inspection told us they felt able to speak with leaders about difficult issues and when things went wrong. Staff told us when practice needed to be improved there was a no blame culture and they were supported to learn and develop within their roles. Comments from staff included ‘I wouldn’t work anywhere else’, ‘the leaders are really supportive’ and ‘I love working here’.

The trust had a freedom to speak up strategy but the posts within the maternity department had yet to be filled. Leaders told us this was an urgent priority for the organisation.

The service valued diversity in their workforce. Staff worked towards an inclusive and fair culture by improving equality and equity for staff who work for them. Staff we spoke with on the inspection described a supportive and improved approach to leadership within the maternity department.

Staff had clear responsibilities, roles, systems of accountability and good governance. Staff used these to manage and deliver good quality, sustainable care, treatment and support. Staff acted on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

There was a clearly defined governance structure which detailed the governance oversight and accountability from the service level to the trust board. Leaders operated an effective governance process and monitored key safety and performance metrics through a structure of governance meetings.

Staff at all levels could describe their role in the governance process and had regular opportunities to meet discuss and learn from the performance of the service. They knew how to escalate issues to the clinical governance team and divisional management team.

Governance meeting agendas included discussion around all aspects of governance and oversight of the data. Data discussed included performance data, audits and training, feedback, training, guidelines and research. During the inspection we reviewed a number of audits including MEWS (maternity early warning score), NEWS (national early warning score) and LocSSIP (Local Safety Standards for Invasive Procedures) and found they were fully completed and discussed by the maternity team.

The service provided assurance to the trust board through their Maternity and Neonatal Assurance Group (MNAG) and reported directly to the trust board through the Quality and Safety Committee. The chief nurse chaired the MNAG, which provided executive oversight. It was also attended by the non-executive director who acted as the safety champion for maternity.

We reviewed trust board minutes which showed that maternity items were regularly part of the agenda. Items included serious incidents, performance reports, performance data and Clinical Negligence Scheme for Trusts (CNST).

The service understood their duty to collaborate and work in partnership, so services work seamlessly for women. Staff shared information and learning with partners and collaborate for improvement.

Leaders worked with the local Maternity and Neonatal Voices Partnership (MNVP) to contribute to decisions about care in maternity services. Service leaders had built genuinely meaningful relationships with the local MNVP and encouraged them to attend meetings on site. The MNVP were passionate about their role and had regular contact with leaders to make a difference to services provided to women. The MNVP also conducted regular walk arounds of the maternity unit to speak to staff, women about their experiences and how things could be improved.

The MNVP engaged with charities and organisations to address inequalities and improve the experience and outcomes of women and families. The maternity service had developed links with the local asylum-seeking women who were pregnant. As a result of this we were told services had been redesigned so the blood test result followed the woman wherever she was relocated in the country. As a result, the antenatal team caring for the woman had up to date clinical information.

The service focused on continuous learning, innovation and improvement across the organisation and local system. Staff encouraged creative ways of delivering equality of experience, outcome and quality of life for women. Staff actively contribute to safe, effective practice and research.

There was a maternity improvement and transformation manager in post. They described their pride in the improvement journey the unit had been on and how working together as a team they had developed the 6 work streams of improvement. Coordinated learning was provided to all grades of staff, for example band 7 and 8 midwives, including the community team, were offered training in leadership and culture. The service prioritised hearing the voices of women who gave birth in the unit. Every woman received a call 6 weeks after the birth of their baby and was asked to provide feedback on their experience. Over 90% of women would be happy to come back and have their baby at this hospital.

All staff we met were committed to learning and improving services. They had a good understanding of quality improvement tools and had the skills to use them. Leaders encouraged innovation and encouraged research. We saw several examples of initiatives, innovations and quality improvement. For example, following user feedback the team had created a family bathroom which was inclusive for the women and their partners to use.

The patient experience midwife team had collaborated with the Maternity and Neonatal Voices Partnership to develop a welcome booklet for the labour ward. In addition, several ‘easy win’ improvements had been made. For example, soft close bins had been purchased, and the buzzer system had been improved to reduce the sounds overnight in the maternity unit.