Maternity

The story of our work with maternity services...

Being Open

EC4H was commissioned by Health Improvement Scotland and the Scottish Government to implement ‘Being Open’ as applied to maternity services. Being Open is a guidance framework to enable services to respond openly and honestly when an adverse event occurs in care. It builds on earlier national patient-safety frameworks and the legal and professional duties around candour. EC4H successfully tested and replicated a trauma informed communication programme to help staff in maternity services to;

Acknowledge when something has gone wrong,
Provide a transparent explanation of what happened,
Offer an apology and support to those affected by the adverse event,
Be more open to learn from events so that services can improve and reduce the risk of recurrence.

Using a Quality Improvement approach to change systems across 2 NHS Boards from 2014-2017, we demonstrated how the communication framework could be fully implemented. The benefit of this approach was highlighted in the Scottish Government Adverse Event Review Guidance in 2021. The review of the implementation of this guidance, by the Scottish Perinatal Network SAER group over 2021-2023, formally recommended that specialist communication training (as established by EC4H) was implemented nationally across all maternity units, facilitating a national approach to family engagement as part of the review process and in recognition of the psychological burden experienced by teams due to the anxiety about blame and external reviews.

Patients and families reported how they appreciated the open approach being taken, how they valued their questions and concerns being incorporated into the adverse event reviews and through this process, how they were more likely to trust the findings of the adverse event reviews. This helped them to adjust and an opportunity to move on in their lives.

Staff experienced greater support during the process of the adverse event reviews and the open approach enabled them to recognise the learning that was important for the service. The ongoing engagement with families during the adverse event investigation enabled a different kind of conversation at the review meetings when the outcome of the investigations was shared; staff reported the meetings as being more open, candid and trusting.

Combining Coaching and Tailored Trauma Informed Communication Training

NHS England commissioned EC4H/Cutting Edge Psychology to work with those services in London which are supported by the Maternity Safety Support Programme (MSSP). The initial phase of work in 2025 involved an extensive scoping; we recognised and understood how staff in those maternity services under escalation felt scrutinised by the burden of multiple reporting in a complex system. This was at times overwhelming as they worked hard to implement the operational changes required alongside the pressure of highly busy services.

There were also excellent examples of local leadership and an enthusiasm for co-production of solutions.

We worked collaboratively, empowering leaders to communicate with compassion, promoting conversations about safety, improvement and culture. The trauma informed communication training that we had applied effectively with Being Open was adapted with this tailored intervention. Participants reported how they had found this approach beneficial in helping them to implement psychologically informed approaches that promoted organisational learning. We were able to draw upon the 23 years of experience and evidence that we had accumulated in EC4H since its inception, we know that what we do works.

This work aligns with key recommendations from the Birth Trauma Report and the Ockendon Report, emphasising the need for systemic improvements, including better training and fostering an open culture of safety and respect.

The team offer coaching to staff working in maternity services to support the implementation of change - find out more