Improving the quality of induction of labour in maternity services.

Background: Induction of labour (IOL) is the most common obstetric intervention with an incidence up to 30%. It can have a major impact on a woman's birth experience. A common cause of women's dissatisfaction with care is the discrepancy between their expectations and actual birth experience.

Local problem: High rates of IOL, which were associated with a considerable number of complaints as a result of women's dissatisfaction with increased referrals to debrief clinics. Staff feedback showed inconsistencies with the service provided. Feedback from staff and women showed avoidable delays, stress and anxiety. Inadequate patient information leaflets provided the women with unrealistic expectations about the IOL process.

Aim: Improving the quality of the IOL process from the point women are offered IOL till delivery, reducing the avoidable delays, standardising the process and ultimately improving women's experience between July 2020 and July 2021.

Methods: We followed the quality improvement methodology; Plan, Do, Study, Act. The project started with baseline data collection with multidisciplinary engagement with stakeholders and service users, including pregnant women, asking for their experience and expectations. This identified the root causes and drivers for change. We identified inconsistencies in the labour induction process as it was not in line with the national guideline, resulting in avoidable delays. Then we started implementing the required changes with continuous engagement with staff and service users, followed by an evaluation of the services.Quality improvement is a continuous process. Hence, the induction of labour working group evaluates the process monthly through the maternity dashboard, women's feedback and satisfaction survey with the help of the quality improvement team.

Intervention: (1) Multidisciplinary IOL working group was established, including a consultant obstetrician, deputy head of midwifery, consultant midwife, senior midwife and senior registrar. (2) Engagement with stakeholders and service users. (3) Develop IOL guidelines to standardise the process. (4) Develop IOL booking pro forma. (5) Update the patient information leaflets and use of technology to help easy access to information and develop a dedicated team for booking of pregnant patients for IOL.

Discussion and conclusion: A high rate of IOL is associated with a higher rate of women's dissatisfaction as a result of the difference between women's expectations and their experience. This occurred due to a lack of standardisation and avoidable delays. Implementation of service changes can be challenging; however, listening and engaging with service users is essential to overcome these challenges. The main keys for improvement were developing standard guidelines, pathways, IOL packs and multidisciplinary team engagement. Providing the women with adequate patient information leaflets helps them to have a shared understanding of the process.