Independent evaluation of NHS England's Perinatal Culture and Leadership Programme

NHS England's Perinatal Culture and Leadership Programme (PCLP) is part of the NHS three-year delivery plan for maternity and neonatal services to improve the quality and safety of care. The programme focuses on equipping senior leaders to create the conditions for a culture of openness, safety, and continuous quality improvement through positive, inclusive and compassionate leadership.

The PCLP brings together senior leaders within organisations – including Operational Managers, Heads/Directors of Midwifery and Clinical Leads for Obstetrics and Neonates – as a quadrumvirate or ‘quad’ to collectively participate in the programme. They are then expected to work together to implement their learning among the wider perinatal team of their unit. The programme began in November 2022, with five intakes or cohorts, covering all 150 NHS maternity and neonatal sites in England.

NHS England has commissioned our team to evaluate the implementation and impact of the PCLP on the ‘quads’ and wider perinatal teams in terms of changes in leadership behaviours and organisational culture.

The evaluation is composed of three phases of work:

• Semi-structured interviews: we are interviewing quad groups (usually comprising four colleagues) from 18 Trusts to a maximum of 60 interviews. We ask focused but open-ended questions to explore participants’ experiences of taking part in the PCLP and of implementing their learning from the programme. We also ask about their views on leadership and the culture of safety in their service and whether this has changed over time or since participating in the PCLP.

• Surveys: we have devised an online survey based on the initial data collected from the qualitative interviews. This quad survey aims to capture views from all those quads in England that we did not interview in the previous phase of the evaluation. We will also circulate a staff survey to capture views of leadership and culture from the wider perinatal team, to help us understand whether things have changed at work since the programme was implemented.

• Rapid focused ethnography and observations: our evaluation team will visit a sample of 6-10 units for short visits of between 4 and 8 days to get a better understanding of what the local leadership and culture look like in practice and to gather a wider range of views from the perinatal staff teams.

  Methods will include observation of day-to-day activities and interactions; observation of key meetings between quads and their teams, and with other senior leadership team (SLT) members, and/or other managers, Board members, and staff; semi-structured or ad hoc interviews with key staff during the visit; and small focus groups with staff in similar roles. 

  Across all observations, the researchers will aim to capture instances and extent of the following behaviours, actions, and interactions as outlined in the PCLP theory of change: 

• Visibility 
• Availability 
• Engagement 
• Responsiveness 
• Active listening 
• Civility 
• Distribution of decision-making and responsibility 
• Inclusivity/inviting participation 
• Integrity/consistency across contexts and status hierarchies 

All the data we gather will be treated confidentially and any interviews or observation notes will be anonymised by the researchers.

• Dr Nimarta Dharni (Co-Principal Investigator)
• Prof Sara Kenyon (Co-Principal Investigator)
• Prof Graeme Currie (Co-Investigator)
• Prof Justin Waring (Co-Investigator)
• Samantha Russell (PPI representative)
• Dr Sam Watson (Co-Investigator)
• Dr Laura Noszlopy (Research Fellow)
• Dr Tommer Spence (Research Fellow)

If you have any questions or concerns, please contact us at pclpevaluation.birmingham@contacts.bham.ac.uk and we will respond as soon as possible.

If you arrived at this page via the QR code on a poster in your unit, you are likely to be having a site visit from either Laura or Tommer, who are collecting data for the evaluation. You may see them at team meetings or quietly observing activities and interactions around your unit, though they will do their best to not to get in your way and they won’t be observing any clinical interactions with women, babies, or their families.

Laura or Tommer may ask to speak with you and to hear your views on the leadership and safety culture where you work. They may also invite you to arrange a short informal interview at a time to suit you, or perhaps invite you to join a small group discussion with a few of your colleagues. Sharing your experiences and perspective will help us evaluate the impact of the programme more fully and accurately, however, it is completely up to you whether you take part.

What are the benefits and risks of taking part?

You will have the chance to share your views and experience of the leadership and culture on your unit. This will help provide learning to NHS England on how effectively the PCLP has been implemented and any potential challenges and impacts that have been identified.

We do not expect there to be any risks involved in taking part in this study. In the unlikely event that information is given that indicates potential harm to women or their babies, our team has a professional accountability and duty of care to report these issues to the relevant maternity Trust management team.

How will we use information about you?

Nothing we publish in relation to this evaluation will identify individuals or specific units or NHS Trusts. The information we collect during site visits will be anonymised, so anything you share will be given an anonymous identifier or code. We will keep all information about you safe and secure. 

In the UK all research must follow both the General Data Protection Regulation (GDPR) and the Data Protection Act 2018 rules. We may collect information about you including your name, role, place of work, and contact details. We will do this to make sure that we are interviewing the correct people for this study and are able to arrange an interview with you. People outside of the research team will not be able to see your name or contact details.

Our university policy states that we must keep all other research data securely on file for 10 years so that study findings can be checked.  We need to manage your data in specific ways for the research to be reliable.  This means that we won’t be able to let you see or change the data we hold about you. You can find out more about how we use your information by:

Asking any member of the research team or contacting the University of Birmingham Data Protection Office at dataprotection@contacts.bham.ac.uk

What will happen to the research information?

We will analyse the information from all the interviews, surveys, and observations to help build up a picture of different experiences of participating in the PCLP and any impacts from implementation of the learning. The results will be written up in a report to be shared with NHS England. We may also publish findings from the study in peer-reviewed medical journals or at conferences.

Who is organising and funding the research?

We are a team of health researchers based in the Institute of Applied Health Research at the University of Birmingham. We have been commissioned to independently evaluate the Perinatal Culture and Leadership Programme by NHS England. This is an independent service evaluation with full ethical approval from the University of Birmingham Ethics Committee [ERN2116-Feb2024].

The findings from this evaluation study will be shared through:

•  the evaluation report to NHS England
• peer reviewed publications
• presentations at local and national conferences relevant to maternity safety

Dissemination of findings will also take place through the NIHR ARC West Midlands networks and NHS England channels.