• Led by University College London Partners, with other partners including Mumsnet and Camden Social Enterprise.
  • Based at the antenatal clinic at University College London Hospital (UCLH) and two clinics at Barts Health NHS Trust – at Newham University Hospital and Barking Birth Centre.
  • Aimed to create cultural change and system transformation to place the needs and preferences of women at the centre of antenatal care.
  • Designed an intelligent internet-based system, co-designed by mums-to-be and health care professionals, that coordinated many aspects of antenatal care.

The team achieved genuine change in the dynamic between health care professionals and mothers-to-be by:

  • testing group consultations for the initial ‘booking’ appointment and at 16 weeks
  • developing a range of online tools for use by women receiving antenatal care – a Facebook group, the MyPregnancy Journey website and the MumsTalk social network
  • engaging participants in project design, through co-design workshops
  • incubating the model with three initial sites, using ethnography to help demonstrate to staff the project’s potential
  • scaling it up across the region, using established change-management and patient-pull approaches.

Key findings:

  • Group appointments have a greater impact at 16 weeks than at the initial booking, where midwives need to communicate a lot of information and women are less likely to interact.
  • Moving from individual to group appointments is more efficient, reducing midwife time.
  • Taking part in 16-week group appointments improved women’s perception of care.
  • Well-designed online information and tools can improve women’s experience of care by helping them feel better informed, more prepared and more in control of their pregnancy.

Challenges faced:

  • Collecting data from service users was difficult due to lack of engagement from clinical and administration staff.
  • Completed questionnaires revealed high levels of satisfaction with current standards of care and the new intervention, suggesting that the questions were not sensitive enough to measure changes.
  • There was strong resistance to change among all levels of staff.
  • The project’s focus on measuring changes in relationships did not resonate with managers whose services were evaluated in different ways.
  • There was tension between service efficiency and patient outcomes. Service managers were more motivated by efficiency savings, while frontline clinicians were more motivated by meeting women’s needs.

Who was involved?

The project was led by University College London Partners – an academic health science partnership between UCL, UCL Hospitals and NHS trusts in north-central London.

Partners included:

  • Mumsnet website
  • NHS North Central London Commissioners
  • Camden Social Enterprise
  • North East, North Central London and Essex Health Innovation Education Cluster
  • Innovation Unit
  • Tribal Education Ltd
  • Microsoft

These partners also engaged local user groups, GPs, midwives, obstetricians and commissioners.

About this programme

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Closing the Gap through Changing Relationships

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