Celebrating clinical partnerships

2020 started very positively as a special year to commemorate the Year of the Midwife and Nurse and as part of these celebrations I had organised an exhibition of breastfeeding paintings and a series of events at BU with my university colleagues and also supported by the Royal Society of the Arts with whom I am a Fellow and a founding member of the Health, Care and Wellbeing Network. The exhibition and series of events unfortunately had to be put on hold after the inauguration because of the pandemic. We do hope to be able to reconvene some of these sessions in the future.

I along with Professor Edwin van Teijlingen and Dr Latha Vinayakarao (Obstetrician at Poole Hospital and Visiting Fellow) and a collaborator from Germany have set up a unique study to evaluate the impact of the pandemic and lockdown on pregnant women and their infants. The 1st phase of this study which focuses on mental health in pregnancy in the U.K. during the pandemic has already recruited about 2000 women.  Further details can be found here.

In view of our previous work and interest in fathers’ experiences, we have setup a global group of researchers to work on this field. I am the Research Chair of this group and this year we formally came together as the FINESSE group with Professor Edwin van Teijlingen and Jillian Ireland as the other members associated with BU.

We have just launched an international survey of fathers’ experiences of neonatal care during the pandemic and lockdown and will share findings in due course. Further details about the group and its work can be found here.

While these are all positive developments we have continued to struggle on some fronts. For example, we still have not been able to secure any funding for our smoking cessation device and research programme with which Dr Humaira Hussain at BU along with Professor Edwin van Teijlingen are involved. In addition to my full time clinical role at Poole, I also have leadership and improvement roles regionally and nationally, including the South Western Ambulance Service NHS FT, Strategic Clinical Network, Hampshire and Thames Valley, NHSEI, Wessex AHSN and the Health Foundation as a Q fellow. As part of these various roles, I not only get an opportunity to serve healthcare in various domains but also get to network and collaborate at multiple levels.

I welcome anyone within the BU teams who wishes to contribute to any of our current programmes of work or collaborate on any new work. Please feel free to contact me on [email protected] and we can discuss ideas. I would welcome new ideas about research and improvement work. Also do join me on Twitter @mkrettiwt

Conducting research in a clinical environment is a privilege but also a big responsibility. I was aware of this as I commenced a period of orientation in DCH maternity services. I had been appointed to design and conduct a research project with a small team from CMMPH to explore maternity culture and organisation. As I hadn’t worked in maternity services in the NHS since the 1990s though, it was vital to understand what had changed, how it functioned and what were the pertinent issues before I made any decisions.

I was extremely fortunate to be welcomed by the Head of Midwifery Services, Dr Jo Hartley. Jo is enthusiastic about research, committed to reflexive practice and passionate about ensuring a maternity service that is of the highest standard possible. She facilitated my orientation enabling me to shadow staff members (including herself) throughout the unit and community, as well as attend meetings from ward to Trust Headquarters and Clinical Commissioning Group. She made time to listen to my latest observations or reflections, answer my questions or brainstorm together. She has been open to my input, and at the same time helped me to be reflexive - to ‘tread carefully’ in a demanding environment where staff are highly committed, expect a lot of themselves and can be easily discouraged. On a practical level Jo has helped me think through the challenge of conducting research in an unpredictable clinical environment without placing more pressure on staff. This relationship has been vital to the development of a study that I know is more grounded in the reality of the everyday lives of staff than I could have developed in isolation.

DCH has a thriving Research and Innovation Department and is part of the Clinical Research Network Wessex and Research Active Dorset. From the initial discussions at DCH the Head of Research, Dr Zoe Sheppard, has been very supportive. She has shared her knowledge of research in an NHS institution, provided links to resources and pertinent local studies, introduced me to key people in the organisation and suggested amendments to the study protocol to ensure it was in line with NHS ethical requirements. I have appreciated being able to drop by her office, ask her advice and discuss options, and learn from her experience.

It has also been important to network with the DCH Organisational Development and Wellbeing leads, to explore ways that our research is can complement other hospital initiatives. We have agreed that this will be an ongoing dialogue as we consider how we can work together, share findings and replicate successful initiatives.

Collaboration takes time. Working as a researcher with clinical partners has meant being ready to wait as clinical demands always come first. It has also meant delays as other people’s perspectives and insights have led to fundamental changes in the study design. Working with clinical and institutional partners, however, has been invaluable in helping ensure that our research is relevant to the ‘real world’, and includes and respects the experts - those who are already investing their time and energy in the setting. As we prepare to commence our study with all the additional challenges posed by this pandemic it is reassuring to know that we have such great partners at DCH and that together we can find a way through the undoubted challenges ahead.

The EXON Continuous Professional Development (CPD) unit provided by BU requires students to have clinical access to newborn babies and their families as it aims to equip health professionals with theoretical and work-based experience in order to achieve competency in assessing newborn health during the examination of the newborn. The practical aspects of the EXON unit typically takes place in teaching hospitals in England and therefore partnerships such as in this case, are important, as collaboration between the two institutions provides a means to bridge the practice-theory gap whereby best practice outcomes are realised. For example, case studies with detailed description of the situations (missed hip problem etc.) are regularly presented and debated. There are many advantages in using case studies as a teaching tool as it requires members of the forum to consider complexity, decision making and ambiguities that have emanated directly from practice.

Developing strong partnerships helps to ensure best practice, therefore as an educator, I am kept up to date with internal processes around the newborn infant physical examination both at national and at local level, which enables my teaching around EXON to be contemporary and relevant to the students undertaking my unit and when teaching undergraduate midwifery students in the wider midwifery curriculum.  I believe that over the years a strong trust has developed between the hospital (maternity services) and academia because members of the EXON forum collaboratively learn together and collectively, we adopt and implement the latest recommendations to provide an excellent newborn examination service to women, their babies and to their families at SFT.