What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?​

Nationally, maternal mortality rates in Black women are four-times that of White women(1) and maternal health is a priority in NHS England’s Core20plus5 health inequalities strategy. Evidence suggests these disparities stem from structural racism in care processes, inequalities in experience, and mistrust in public services and institutions(2,3). Listening events by Hammersmith & Fulham council with Black communities have shown these negative experiences impact health-seeking behaviours, impacting access and health outcomes. Our previous community Big Rooms in Westminster and Kensington & Chelsea with service users, voluntary sector maternity champions, and the NHS showed service users want culturally respectful and holistic maternity services. While co-producing service improvements with communities across an integrated care system is recognized for reducing inequalities(4), practical and scalable improvement approaches boosting the culture, capabilities, and structures needed for learning and improvement with minority ethnic service users  across an integrated care system (NHS, local authorities, voluntary sector) remains an important gap.

What does your project aim to achieve?

As a systems approach to quality improvement can significantly improve patient and service outcomes(5), our project aims to bring together the diverse perspectives and capabilities of the ICS stakeholders (NHS, local authority, voluntary sector) and provide insights on how to co-produce with Black women and their families culturally appropriate and holistic service improvements to reduce ethnic inequities in maternity care experience.

Therefore, our objectives are to:

1. Collectively reach consensus with Black maternity service users and their families, and ICS stakeholders on improvement areas needed to reduce ethnic inequalities in maternity experience. (in progress)
2. Co-produce an intervention to reduce inequities in maternity experience in partnership with Black women and their families, and ICS stakeholders.
3. Evaluate the individual, organisational, and system factors that enable culture, capabilities, and structures needed to meaningfully involve minority ethnic service users and ICS stakeholders to co-produce and productively deliver service improvements sustainably and at scale.

How will the project be delivered?

Step 1 – Consensus-building (in progress): We are currently identifying improvement areas from service users, voluntary sector, NHS (Imperial College Healthcare NHS Trust, northwest London (NWL) GP practices & community midwives, NWL ICB), and local authorities (Hammersmith & Fulham, Westminster City). All stakeholders will develop and vote on a shortlist of priorities, where one will undergo co-production.

Step 2 – Co-production: Using a double-diamond approach, community engagement specialists from Listen to Act will facilitate four co-production workshops with service users and ICS stakeholders to co-develop the intervention.

Step 3 – Evaluation: Imperial College London study team and two community researchers will co-develop and conduct semi-structured interviews and focus groups with service users and ICS stakeholder to understand factors affecting meaningful co-production.

Q Exchange funds will enable service user engagement activities in steps 2 and 3.

A project steering group comprising of Black maternity service users and one representative per ICS stakeholder group will provide overall guidance and support risk management.

How is your project going to share learning?

Learnings from this project will be used to:

• Produce an insight report illustrating how ICS stakeholders (NHS, local authorities, the voluntary sector) and service users can collectively prioritize and co-produce service improvements to reduce ethnic inequities in experience of maternity care.
• Shape improvement tools and approaches that can be used by other ICSs to co-produce equitable and respectful maternity services with minority ethnic service users.

We will share our project experiences via Q community blog posts and special interest groups so we can continuously learn from other members to refine our approach.

Our community communication plans will be co-developed with community champions and service users so we can regularly share progress and appropriately ask for feedback.

We will also share our findings with the NHS, social care organisations, and local authorities through national and local meetings, communities of practices, webinars, and conferences so that others can consider adopting our approach.