Neonatal Care in Scotland: A Quality Framework

3.4 Effective

A high quality service with an effective governance structure will demonstrate the use of quality indicators to monitor and improve outcomes and will produce an annual report evidencing the planning and delivery of continuous improvement in the service for each regional MCN. This will include information from each unit; the collection and management of data and appropriate leadership and management arrangements the development, implementation and regular review of evidence-based guidelines and quality indicators; benchmarking activity to compare the efficacy of the Scottish service with others; contribution to research work and access to appropriate developmental care. This will be supported by active engagement with staff at all levels.

3.4.1 Leadership and Management

A high quality neonatal service will ensure there is an effective and accountable governance structure with strategic leadership and direction that will support an effective and efficient service.

This will be evidenced by:

• A robust governance framework agreed by each Regional Planning Group identifying lines of accountability and responsibility which protects both patient safety and the clinical staff delivering care in NHS Boards.
• A strategic plan for the development of capacities and skills to improve clinical care which includes leadership development, staff governance and workforce.
• Professional leads at a local and regional level covering:
  • Surgical services
  • Education
  • Service development
  • Transfer service
  • Data and audit
  • Research
  • Follow-up

It is recognised this may form part of the responsibilities for an existing member
of staff.

• A professional lead at a local level interfacing with the MCN. This lead will identify local leads for the following aspects of service:
  • Service delivery
  • Breastfeeding
  • Developmental needs and care of the baby
  • Emotional and psychological support to families
  • Safeguarding children/child protection issues
  • Infection control
  • Patient safety
  • Palliative care
  • Bereavement support
  • Education and training
  • Community liaison

This individual will have the responsibility for escalating issues in any of these areas to the MCN. It is recognised this may form part of the responsibilities for an existing member of staff.

3.4.2 Quality Indicators

MCNs will support the delivery of a high quality neonatal service by taking a lead in the development and monitoring of Quality Indicators.

This will be evidenced by:

• The MCNs agreeing clinical quality indicators and reviewing these regularly, to monitor the quality outcomes of services within that network.
• An annual multi-disciplinary meeting involving all key stakeholders being held to monitor trends in outcomes (including mortality and morbidity).

3.4.3 MCN Annual Report

The effectiveness of a high quality neonatal service will be highlighted by the production of an annual report from each regional MCN (accountable to respective Regional Planning Groups).

This will include:

• A report from each network subgroup to evidence regional working which incorporates the identification, sharing and learning from the delivery of best practice.
• Each network meeting or working toward the completion of identified objectives which are aligned with their respective Regional Planning Group objectives.
• Each network following recommendations as set out in relevant Scottish Government strategic policy documents such as the NHSScotland Quality Strategy.
• Each network showing added value to healthcare in Scotland through improved outcomes and processes.

3.4.4 Evidence-based Guidelines

A high quality neonatal service will show regional collaborative working to agreed guidelines for care, based, wherever possible, on the most up-to-date available evidence.

This will be evidenced by:

• Professionals following agreed professional diagnostic and therapeutic guidelines wherever clinically possible.

3.4.5 Benchmarking

A high quality neonatal service will provide access to robust quality data on neonatal care, mortality and morbidity from all units within the region. This will enable contribution to network, national and UK audit in order to provide benchmarking information.

This will be evidenced by:

• Contribution to the Scottish neonatal dataset supported by effective data collection systems within the region. Data to be used to support continuous quality improvement.
• Submission to the National Neonatal Audit Programme (NNAP)

3.4.6 Research

High quality neonatal services encourage participation in research and development activity, which supports collaborative working across the region and will have a structure in place to support interaction and engagement with the National Institute for Health Research and its networks.

This will be evidenced by:

• Recorded support of study-related handovers during transfers.
• Unified policies, where multiple trials are taking place.
• The provision and recording of Good Clinical Practice (GCP) training in the areas of research processes for staff participating in research.

3.4.7 Developmental Care

Developmental care is the culture within the unit that recognises and supports the developmental needs of all infants at all stages within the neonatal environment. Access to appropriate developmental care at the right time can have a positive impact on the future health of the child and improve the effectiveness of care.

This will be evidenced by:

• The establishment of a multi-disciplinary developmental care group.
• Guidelines for delivery of developmental care, supported by education and training for staff.